What are social determinants of health?

The term “social determinants of health” grew out of researchers' search for the specific mechanisms by which members of different socio-economic groups come to experience varying degrees of health and illness^[11][12] Everywhere, individuals of different socio-economic status show profoundly different levels of health and incidence of disease.^[13][14]

Another stimulus to investigating social determinants of health was the finding of national differences in population health. For example, the health status of Americans—using indicators such as life expectancy, infant mortality, and death by childhood injury rates—compares unfavourably to citizens in most industrialized wealthy nations.^[15] In contrast, the health status of Scandinavians is generally superior to that seen in most nations.^[16] It was hypothesized that perhaps the same factors that explain health differences among groups within nations could also explain differences among national populations.

A variety of approaches to the social determinants of health exist and all of these are concerned with the organization and distribution of economic and social resources among the population. The Ottawa Charter for Health Promotion identifies the prerequisites for health as peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.^[17] Health Canada outlines various determinants of health—most of which are social determinants—of income and social status, social support networks, education, employment and working conditions, physical and social environments, biology and genetic endowment, personal health practices and coping skills, healthy child development, gender, culture, and health services.^[18]

A British working group charged with the specific task of identifying social determinants of health named the social (class health) gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food, and transport.^[19] And the U.S. Centers for Disease Control and Prevention highlight social determinants of health of socioeconomic status, transportation, housing, access to services, discrimination by social grouping (e.g., race, gender, or class), and social or environmental stressors.^[20]

Canadian workers synthesized these formulations to identify 12 key social determinants of health: Aboriginal status, early life, education, employment and working conditions, food security, gender, health care services, housing, income and its distribution, social safety net, social exclusion, and unemployment and employment security.^[21] These determinants are especially relevant to understanding and improving the health of Canadians. Evidence indicates that the health-related effects of each and every one of these factors equals or exceeds the influence of the so-called “lifestyle” or behavioural risk factors such as tobacco and alcohol use, diet, and physical activity^[22][23], a conclusion stated as early as the mid 1970s.