Social determinants of health
Social determinants of health refer to the various social factors that influence individual health outcomes. These determinants include aspects such as socioeconomic status, gender, marital status, and ethnicity, all of which contribute to disparities in health across different populations. The social environment, characterized by relationships and support networks, can have both positive and negative impacts on health, often mediating the effects of stress and resources available to individuals. Additionally, the natural and built environments play a significant role, as individuals in underprivileged communities often face greater exposure to pollution and hazards due to socioeconomic and racial inequalities.
Health-related behaviors, including diet, exercise, and substance use, are also shaped by social contexts, cultural norms, and economic factors. Access to healthcare is another critical determinant, heavily influenced by the structure of the health care system and geographical considerations. For instance, individuals from low-income backgrounds may encounter barriers to obtaining adequate healthcare services, exacerbating health disparities. Overall, the interplay of these social determinants highlights the importance of addressing social inequalities to improve overall health outcomes and promote health equity within populations.
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Subject Terms
Social determinants of health
Social factors have an influence on individual health, as shown by disparities in the health outcomes of individuals according to gender, marital status, socioeconomic status, and ethnicity. The need to address these disparities is increasingly regarded as a social and political issue and has been recognized in public policies in many countries. The social environment can have a negative or positive influence on health, through factors such as social stress or support of social networks. The influence of the natural and built environment on individual health is also mediated by socioeconomic factors. This is, for example, the case of exposure to pollution, natural hazards, and accident risk. Society also constrains behaviors linked to health outcomes, such as diet, physical exercise, substance abuse, and visits to health care facilities. The organization of the health care system and the geographical context are also relevant.
Background
Social factors have an influence on individual health because they shape people’s lifestyles and living conditions. These factors may lead to health disparities of individuals that are linked to characteristics such as gender, marital status, socioeconomic class, and ethnicity.
The “biomedical model” has been the dominant approach to health and illness since the late seventeenth century. This model looks at illness as a physical problem that can be analyzed objectively using modern Western medicine. This model lost some its relevance during the twentieth century, as infectious diseases were replaced by chronic and degenerative diseases as the main causes of mortality. These diseases are often linked to lifestyles and thus have social determinants. In the 1970s, George Engel proposed a “biopsychosocial model” to take these determinants into account. The idea that health is related to social factors was later consolidated in a series of papers by Bruce Link and Jo Phelan during the 1990s.
Empirical evidence on the multiple links between health and society has also grown since the 1970s. Richard Wilkinson and Kate Pickett’s The Spirit Level, first published in 2009, presents an overarching theory supported by evidence that economic inequality is directly related with a large number of health and social problems. This pattern is explained by factors such as social stress and social cohesion.
Activists have also approached this issue in terms of social justice. The environmental problems in the Love Canal neighborhood of Niagara Falls, New York, led to major protests in the late 1970s, which shaped what is now known as the environmental justice movement. This movement asserts that underprivileged communities and ethnic minorities should not be disproportionately exposed to environmental risks. This principle has become law in the United States through Executive Order 12898 of February 11, 1994.
The impact of research and activism has contributed to the growing consideration of social factors in national and international health policies. For example, the World Health Organization established a Commission on the Social Determinants of Health from 2005 to 2008, which produced evidence of existing issues and actions for tackling them.
Overview
The social environment is an important component of individual health. Stress is often rooted in problems in human relationships. The incidence of stress tends to be associated with lower socioeconomic status, due to the impact of problems related to income and employment. The existence of a meaningful social network surrounding the individual may, however, contribute to the prevention of illness or the mitigation of its effects.
The influence of the natural and built environment on individual health is also mediated by social factors. Evidence shows that underprivileged communities and ethnic minorities tend to be disproportionately exposed to pollution. This may be explained by their lack of political power or by restrictions to residence location such as class and racial segregation and discrimination in the housing market. Children from poor families and ethnic minorities are also at a higher risk of pedestrian accident risk. The incidence of workplace accidents is also skewed toward individuals with lower socioeconomic status, as they are disproportionately represented in hazardous occupations.
Disparities in health outcomes are also explained by constraints on individual behavior. Access to healthy food may be restricted by economic factors, education, and culture. Social understandings about the body also play a role. For example, excess weight may be perceived as a sign of health and beauty in some societies.
The probability of doing physical exercise is influenced by social understandings and cultural representations of the body. Women in some countries or cultures may face special constraints due to taboos regarding the participation in certain sports, social values, or personal safety concerns about doing outdoor activities. Probability of doing exercise can also be influenced by many other factors, such as the walkability of one's community, access to affordable gym facilities, and other intersectional issues.
The abuse of substances such as tobacco, alcohol, and drugs is rooted in social factors, as it is linked to specific social situations, is used as an antidote to social stress and other personal problems, and is influenced by peer pressure, cultural norms, and media representations. These influences tend to be more relevant for men and individuals with lower socioeconomic status. Other risky behaviors, such as engaging in unprotected sex, may also be correlated with education, taboos, and social understandings of sex and gender.
Society’s choices regarding the organization of the health care system are also an important determinant of individual health. The American model has generated intense public discussion as critics point out that it does not rely on an institutionalized support of the individual by society, thus placing poorer people in a vulnerable position. However, the Patient Protection and Affordable Care Act has attempted to remedy the disparity of health coverage for low-income communities by amending eligibility for Medicaid. Medicaid coverage has been extended to people under sixty-five years old whose incomes are up to 133 percent of the federal poverty level. The governments of some other countries, such as Japan and the United Kingdom, offer universal healthcare to citizens.
Geographical context is also relevant. Differences in health outcomes in urban, suburban, and rural areas may be explained by factors such as stress, isolation, and sense of place. Individuals without access to transportation are also at disadvantage if they live in areas without health care facilities, food shops, or leisure areas accessible by walking or public transit.
Bibliography
Cockerham, William C. Social Causes of Health and Disease. 2nd ed. Polity, 2013.
Crosby, Richard A., et al. Rural Populations and Health: Determinants, Disparities, and Solutions. Jossey, 2012.
Eyal, Nir, et al. Inequalities in Health: Concepts, Measures, and Ethics. Oxford UP, 2013.
Kronenfeld, Jennie J., ed. Social Determinants, Health Disparities and Linkages to Health and Health Care. Emerald Group, 2013.
La Veist, Thomas A., and Lydia Isaac, eds. Race, Ethnicity, and Health: A Public Health Reader. Wiley, 2012.
Lenard, Patti T., and Christine Straehle. Health Inequalities and Global Justice. Edinburgh UP, 2012.
"Social Determinants of Health." Centers for Disease Control and Prevention, 15 May 2024, www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html. Accessed 1 Aug. 2024.
"Social Determinants of Health." World Health Organization, 2024, www.who.int/health-topics/social-determinants-of-health#tab=tab‗1. Accessed 1 Aug. 2024.