Social determinants of health

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Social determinants of health are the economic and social conditions under which people live which determine their health. Virtually all major diseases are primarily determined by specific exposures to these conditions. And these conditions are a result of social, economic, and political forces. Social determinants of health have been recognized by several health organizations such as the Public Health Agency of Canada and the World Health Organization to greatly influence collective and personal well-being. A list of determinants of health -- only some of which are social determinants -- compiled by the Public Health Agency of Canada is below:

1. Income and social status
2. Social support networks
3. Education and literacy, e.g. health literacy
4. Employment/Working conditions
5. Social environments
6. Physical environments
7. Personal health practices and coping skills
8. Healthy child development
9. Biology and genetic endowment
10. Health services
11. Gender
12. Culture

The term social determinants of health grew out of the search by researchers to identify the specific exposures by which members of different socio-economic groups come to experience varying degrees of health and illness. While it was well documented that individuals in various socio-economic groups experienced differing health outcomes, the specific factors and means by which these factors led to illness remained to be identified Overviews of the concept, recent findings, and an analysis of emerging issues are available. All these formulation share a concern with factors beyond those of biomedical and behavioural risk.

The SDOH National Conference list (see Raphael, below) is unique in that it specifically focuses on the public policy environment (e.g., income and its distribution) rather than characteristics associated with individuals (e.g. income and social status). These 11 social determinants of health are:

1. Aboriginal status
2. Early life
3. Education
4. Employment and Working conditions
5. Food security
6. Health care services
7. Housing
8. Income and its distribution
9. Social safety net
10. Social exclusion
11. Unemployment and Employment security.

We might also add in the following social influences:

• Group participation
• Social adjustment
• Social drinking
• Social identity
• Social interaction
• Social isolation
• Social issues
• Social networks
• Social support networks

Sociocultural factors

• Ethnic values
• Minority influence
• Social class
• Social mobility

Direct interpersonal influences

• Abuse
• Authority
• Coercion
• Conflict
• Criticism
• Enabling
• Peer pressure
• Persuasion
• Popularity
• Power and powerlessness
• Prejudice
• Reference groups
• Social approval
• Social desirability
• Social norms
• Superstitions
• Stigma
• Taboos

Social environmental factors

• Social environments
• Academic environments
• Communities
• Home environment
• Poverty areas
• Suburban environments
• Urban environments
• Working conditions
• Cultural deprivation
• Social density
• Social deprivation

See also

• Differential susceptibility hypothesis
• Health literacy
• Population health
• Population Health Forum
• Social influences
• Sociocultural factors
• Whitehall Study

References

• World Health Organization. (1986). Ottawa charter for health promotion. World Health Organization European Office. Available: http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf
• Health Canada. (1998). Taking action on population health: A position paper for health promotion and programs branch staff. Ottawa: Health Canada. Available: http://www.phac-aspc.gc.ca/ph-sp/phdd/pdf/tad_e.pdf
• Wilkinson, R., & Marmot, M. (2003). Social determinants of health: The solid facts. World Health Organization, European Office. Available: http://www.euro.who.int/document/e81384.pdf
• Raphael, D. (Ed.). (2004). Social determinants of health: Canadian perspectives. Toronto: Canadian Scholars’ Press: http://www.cspi.org/books/s/socialdeter.htm
• Raphael, D., Bryant, T., and Rioux, M. (Eds. (2006). Staying alive: Critical perspectives on health, illness, and health care. Toronto: Canadian Scholars’ Press:

http://www.cspi.org/books/s/staying.htm

• Raphael, D. (2007). Poverty and policy in Canada: Implications for health and quality of life. Toronto: Canadian Scholars' Press.
• Raphael, D. (2006). The social determinants of health: What are the three key roles for health promotion? Australian Health Promotion Journal, 17 (3), 167-170.
• Raphael, D. (2006). Social determinants of health: Present status, unresolved questions, and future directions. International Journal of Health Services, 36, 651-677.
• Raphael, D. (2003). Bridging the gap between knowledge and action on the societal determinants of cardiovascular disease: How one Canadian community effort hit -- and hurdled -- the lifestyle wall. Health Education, 103, 177-189.
• Raphael, D., Anstice, S., Raine, K., et al. (2003). The social determinants of the incidence and management of Type 2 Diabetes Mellitus: Are we prepared to rethink our questions and redirect our research activities? Leadership in Health Services, 16, 10-20.
• Raphael, D. (2006). Politics, political platforms, and child poverty in Canada. Policy Options, 7, (6), 99-103.
• Raphael, D. (2003). Addressing the social determinants of health in Canada: Bridging the gap between research findings and public policy. Policy Options, 24, no. 3, 35-40.
• Zarcadoolas, C., Pleasant, A., & Greer, D. (2006) Advancing health literacy: A framework for understanding and action. Jossey-Bass:San Francisco, CA. Available at http://www.amazon.com/dp/0787984337/

External links

• Video: The Politics of Population Health - Lecture by Dennis Raphael
• Video: The Politics of Health in the USA - Lecture by Dennis Raphael at the Centre for Health Disparities in Cleveland Ohio
• Public Health Agency of Canada: What determines health? - Key Determinants
• World Health Organization: Commission on Social Determinants of Health
• Population Health Forum website
• VIDEO: Health Status Disparities in the US featuring Paula Braveman, Gregg Bloche, George Kaplan, Thomas Ricketts, Mary Lou deLeon Siantz, and David Williams