Social Determinants of Health

by

Carles Muntaner, Deb Finn Mahabir, Virginia Gunn

• LAST REVIEWED: 11 July 2017
• LAST MODIFIED: 25 October 2017
• DOI: 10.1093/obo/9780199756797-0150

Introduction

The social determinants of health (SDOH) are a combination of social, economic, and political factors that shape the health of individuals, communities, and populations. These influences determine to a great extent people’s state of health or illness. The decision about how to structure this article was inspired by the three areas of action recommended by the World Health Organization (WHO) Commission on the Social Determinants of Health in their 2008 final report. The main approach adopted in this article reflects a materialist/structuralist perspective, which recognizes that health depends on the ways in which economic and social resources are organized and distributed in a society. Given that the factors affecting health are very complex, the strategies used to address them need to be comprehensive as well, and they could include health promotion approaches, the creation of health policy, and global governance. The behavioral approach is less represented in this article, given that individual choices are strongly influenced by one’s access to material resources and that behavioral risk factors account for a rather small percentage of variation in overall morbidity and mortality rates from various diseases. Studies about health services are also included in this article, given that access and use of health services are greatly affected by factors such as class, income, education, gender, environment, and so on. The article includes a wide range of resources from around the globe and is meant to review the SDOH from an international perspective.

General Overviews

Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health (Commission on Social Determinants of Health 2008) is the final report of the Commission on Social Determinants of Health, a collaboration among scientists, policymakers, and civil society from across the globe. Relying on synthesized evidence from numerous sources, the commission recommended three key areas of focus for the promotion of health equity: daily living conditions, unjust distribution of power and resources, and workforce development to facilitate assessment, evaluation, and action on the SDOH. The reviews conducted in Whitehead 2007 and Marmot, et al. 2010 provide summaries of evidence-informed interventions to address health and social inequalities. Navarro and Shi 2001 presents an analysis of the impact of political traditions on health and social inequalities, and Braveman, et al. 2011 provides a detailed description and analysis of the SDOH, including examples of effective approaches. The authors of Bambra, et al. 2010 conducted a review of the literature to investigate the health effects of interventions addressing the SDOH. Muntaner 2013 comments on the future of social epidemiology and argues that research in this field would benefit from the use of scientific realism, instead of positivism.

• Bambra, Clare, Marcia Gibson, Amanda Sowdon, Kath Wright, Margaret Whitehead, and Mark Petticrew. 2010. Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. Journal of Epidemiology & Community Health 64.4: 284–291.

  DOI: 10.1136/jech.2008.082743

  Synthesizes evidence from thirty systematic reviews conducted between 2000 and 2007 in developed countries.

• Braveman, Paula, Susan Egerter, and David R. Williams. 2011. The social determinants of health: Coming of age. Annual Review of Public Health 32:381–398.

  DOI: 10.1146/annurev-publhealth-031210-101218

  Provides a clear description of the SDOH. It includes examples of upstream and downstream approaches and relevant frameworks and pathways to explain the health impact of the SDOH. Knowledge gaps and priorities for future research are also identified. Main focus is on the United States.

• Commission on Social Determinants of Health. 2008. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, Switzerland: World Health Organization.

  Final report of the Commission on Social Determinants of Health. Based on the premise that health is a basic human need and that health equity is central to the achievement of health, this report presents a synthesis of available evidence on interventions to promote health equity. The issued recommendations focus on national and global action on the SDOH.

• Marmot, Michael. 2015. The health gap: The challenge of an unequal world. New York: Bloomsbury.

  This book provides early-21st-century evidence that health inequities within and between countries are due to social factors. The author asserts that we need to build socially sustainable communities by addressing disempowerment and material, psychosocial, and political factors.

• Marmot, Michael, Jessica Allen, Peter Goldblatt, et al. 2010. Fair society, healthy lives: The Marmot Review; The strategic review of health inequalities in England post-2010. London: Marmot Review.

  This report is based on synthesized evidence and argues that the reduction of health inequalities is an issue of fairness and social justice; formulates six policy objectives to support the reduction of health inequalities.

• Muntaner, Carles. 2013. Invited commentary: On the future of social epidemiology—a case for scientific realism. American Journal of Epidemiology 178.6: 852–857.

  DOI: 10.1093/aje/kwt143

  The author argues that while positivism is a good fit for descriptive and observational accounts of the impact of social factors on health, scientific realism is better suited to facilitate an in-depth understanding of causal mechanisms and the identification of innovative interventions.

• Navarro, Vicente, and Leiyu Shi. 2001. The political context of social inequalities and health. International Journal of Health Services 31.1: 1–21.

  DOI: 10.2190/1GY8-V5QN-A1TA-A9KJ

  The authors suggest that political regimes with a higher commitment to redistributive policies and full-time employment have been generally more successful at improving health indicators, such as infant mortality rates.

• Whitehead, Margaret. 2007. A typology of actions to tackle social inequalities in health. Journal of Epidemiology & Community Health 61.6: 473–478.

  DOI: 10.1136/jech.2005.037242

  A wide range of options for effective interventions to address health and social inequalities is provided. Policymakers, advisors, and practitioners are encouraged to use relevant theory-based approaches for the assessment of interventions.