Public Health 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.

Introductory Works

Lalonde 1974 is the first major government report to suggest that in order to improve health, emphasis should be switched from medical treatments to health prevention and promotion. Through these arguments, the report helped develop the discipline of health promotion and recognized the importance of healthy environments for health. The report is not without controversy due to the inference that individual choices can lead to health inequalities, while the effect of health policies is not considered. World Health Organization 1978 describes the Alma-Ata Declaration, a commitment made during the 1978 International Conference on Primary Health Care, which represents the first international attempt to show the link between primary health and health equity. World Health Organization 1986 introduces the Ottawa Charter for Health Promotion, which builds on the Alma Ata Declaration. The agreement calls for intersectoral collaboration both at national and international levels, to support the achievement of health equity. McQueen 2013 presents an SDOH framework for addressing noncommunicable diseases and is an informative read for professionals, researchers, and students in health promotion, global public health, and epidemiology. World Health Organization 1998 summarizes the “health for all” vision, an extension of the Alma-Ata Declaration, first drafted in 1979. World Health Organization 2011 examines the Rio Political Declaration on Social Determinants of Health, a pledge taken by the member states of the World Health Organization (WHO) to address and reduce health inequities by implementing an SDOH approach. Wilkinson and Marmot 2003 summarizes in plain language key findings on SDOH. Lynch 2000 covers a short history of social epidemiology and notions related to concept development.

  • Krieger, Nancy, Diane L. Rowley, Allen A. Herman, Byllye Avery, and Mona T. Phillips. 1993. Racism, sexism, and social class: Implications for studies of health, disease, and well-being. American Journal of Preventive Medicine 9.6 Suppl.: 82–122.

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    Examines the links between health and the mechanisms of racism, sexism, and social class.

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    • Lalonde, Marc. 1974. A new perspective on the health of Canadians. Ottawa, ON: Ministry of Health and Welfare.

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      Lalonde argues that in addition to health-care services, other factors such as lifestyle, environment, and human biology affect health. For this reason, the “Lalonde Report” played an important role in changing the way health is understood worldwide.

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      • Lynch, John. 2000. Social epidemiology: Some observations about the past, present and future. Australasian Epidemiologist 7.3: 7–15.

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        Covers a short history of social epidemiology and discusses ideas related to concept development. Includes a discussion on the direction of research in this field.

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        • McQueen, David V. 2013. Global handbook on noncommunicable diseases and health promotion. New York: Springer.

          DOI: 10.1007/978-1-4614-7594-1Save Citation »Export Citation » Share Citation »

          Argues that a thorough understanding of social factors is vital when addressing chronic diseases and will lead to more-successful preventive interventions and a more efficient use of resources. Suggests that government, nongovernmental organizations, workplaces, and health and community institutions have to collaborate to address social factors involved in disease production.

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          • Wilkinson, Richard, and Michael Marmot, eds. 2003. The solid facts: Social determinants of health. 2d ed. Copenhagen: World Health Organization, Regional Office for Europe.

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            Brief summary of SDOH, especially as related to their implications for public policy. Large amounts of scientific evidence are synthesized in this publication in a very concise way. Available in over twenty-five languages.

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            • World Health Organization. 1978. Alma-Ata Declaration. Geneva, Switzerland: World Health Organization.

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              The declaration of Alma-Ata states the need for concerted action by governments, communities, and health professionals to protect and promote the health of all people.

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              • World Health Organization. 1986. Ottawa Charter for Health Promotion. Geneva, Switzerland: World Health Organization.

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                This report highlights key areas for action to support the achievement of health equity; these strategies were identified during the First International Conference on Health Promotion organized by the WHO.

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                • World Health Organization. 1998. Health for all in the 21st century. Geneva, Switzerland: World Health Organization.

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                  The “health for all” strategy offers a framework for creating global health equity. This approach calls for national policies that ensure access to vital health care for everyone and a fair distribution of health resources.

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                  • World Health Organization. 2011. Rio Political Declaration on Social Determinants of Health––World Conference on Social Determinants of Health. Papers presented at the sixty-fifth World Health Assembly, held 21 October 2011 in Rio de Janeiro, Brazil. Geneva, Switzerland: World Health Organization.

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                    Strategies and policies included in this declaration address the reduction of health inequities and are largely based on recommendations from the WHO Commission on Social Determinants of Health.

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                    Classic Works

                    This section outlines some of the classic works contributing to the study of the SDOH. Engels 1993 is a reprinting of Friedrich Engel’s first book, published in 1845, in which his preoccupation with the SDOH became evident; it shares findings from a groundbreaking analysis of the impact of social class, income, and living conditions on mortality rates for industrial workers in England. Virchow and Rather 1985 was initially published in 1879; Rudolf Virchow’s concern with the role of social factors in producing disease is apparent in his collection of papers on the topics of public health and epidemiology. His work is still relevant in the early 21st century, despite being written more than a hundred years ago. Navarro 1976 contains a compilation of essays that describe the links between health and social class and constitute another early example of a scientist’s focus on the SDOH. Marmot, et al. 1978, also known as the Whitehall I study, investigates the relationship between social status and mortality rates among male civil servants in London, England.

                    • Engels, Friedrich. 1993. The condition of the working class in England. Edited by David McLellan. Oxford: Oxford Univ. Press.

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                      Engels’s first book and one of his most popular works, this study is a classic example of social epidemiology. Originally published in 1845.

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                      • Marmot, Michael G., Geoffrey Rose, Martin Shipley, and Peter J. Hamilton. 1978. Employment grade and coronary heart disease in British civil servants. Journal of Epidemiology & Community Health 32.4: 244–249.

                        DOI: 10.1136/jech.32.4.244Save Citation »Export Citation » Share Citation »

                        A key finding of this prospective cohort study is that behavioral risk factors have less influence than social factors on morbidity and mortality. Also relevant is the Whitehall II study.

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                        • Navarro, Vicente. 1976. Medicine under capitalism. New York: Prodist.

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                          Contains a compilation of essays that describe the links between health and social class, bringing attention to the need to include health in social research and theory. Through this book, Navarro’s work reached a broader audience, outside the health and medical field.

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                          • Virchow, Rudolf L. K., and Lelland J. Rather. 1985. Collected essays on public health and epidemiology. Vol. 1. Canton, MA: Science History Publications.

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                            In this volume, Virchow, who is recognized as a founder of social medicine, articulates that disease is determined by social conditions—not strictly by biology—and, in acknowledgment, advocates for social and political reform. Originally published in 1879 by Rudolf Virchow.

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                            Textbooks

                            Marmot and Wilkinson 2005, initially published in 1998 and titled Social Determinants of Health: The Solid Facts, constitutes an essential read for public health workers, health promoters, advocates for healthy public policy, and policymakers. Navarro and Muntaner 2014 is a thought-provoking compilation of essays that critically analyze issues of public health associated with the most recent global economic crisis. Raphael 2008 provides insights into the current state of the SDOH in Canada. Rose 2008, originally published in 1992, examines approaches in preventive medicine and constitutes a landmark reading on the topic of population health. Wilkinson 2001 contains an exhaustive exploration of the effect of income inequalities on population health. Richard Wilkinson uses country-specific examples to describe concepts such as unequal societies and social cohesion and the potential pathways linking them to disease. O’Campo and Dunn 2012 offers insightful readings both for new and established social epidemiologists, as well as practicing health workers and graduate students in the health sciences. See also Blas, et al. 2011, cited under Methods and Tools for Research and Monitoring; Kawachi and Wamala 2006, cited under Global Governance; Kawachi, et al. 2008, cited under Social Capital; Krieger 2011, cited under Methods and Tools for Research and Monitoring; Lee, et al. 2002, cited under Globalization and Migration; Navarro 2002, cited under Economics of the Social Determinants of Health; and Oakes and Kaufman 2017, cited under Methods and Tools for Research and Monitoring).

                            • Aneshensel, Carol S., Jo C. Phelan, and Alex Bierman, eds. 2013. Handbook of the sociology of mental health. Handbooks of Sociology and Social Research. Dordrecht, The Netherlands: Springer.

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                              This book contains theory-driven reviews of research to investigate the ways in which society shapes mental health. Social, cultural, and economic factors are examined to understand why some social groups have a greater risk for mental illness.

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                              • Berkman, Lisa F., and Ichiro Kawachi, eds. 2000. Social epidemiology. New York: Oxford Univ. Press.

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                                The first book on social epidemiology, defined by the editors as the study of the social determinants of health, emphasizes the importance of addressing social-environmental factors. Each chapter provides research evidence on specific social determinants, including socioeconomic position and working conditions. The last chapters recommend a multilevel approach to integrate the different levels of inquiry to understand social determinants, and then advocate for changes to social policy to address the social causes of health problems.

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                                • Birn, Anne-Emanuelle, Yogan Pillay, and Timothy H. Holtz. 2017. Textbook of global health. 4th ed. New York: Oxford Univ. Press.

                                  DOI: 10.1093/acprof:oso/9780199392285.001.0001Save Citation »Export Citation » Share Citation »

                                  Using a political-economy framework, this book provides a comprehensive analysis of the social factors that contribute to population health patterns within and between countries.

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                                  • El-Sayed, Abdulrahman M., and Sandro Galea, eds. 2017. Systems science and population health. New York: Oxford Univ. Press.

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                                    This book acknowledges the constraints of traditional reductionist approaches in biomedical and public health sciences. To address the complexity of the social determinants of population health, the authors recommend using systems science.

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                                    • Marmot, Michael, and Richard Wilkinson, eds. 2005. Social determinants of health. 2d ed. Oxford: Oxford Univ. Press.

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                                      This volume contains scientific data on the effects of the SDOH. It describes the impact of social and economic factors on health, with particular focus on how to communicate these messages to policymakers and the public. Contains the evidence to support the World Health Organization’s initiative and 2003 publication The Solid Facts (Wilkinson and Marmot 2003, cited under Introductory Works), originally published in 1998.

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                                      • Navarro, Vicente, and Carles Muntaner, eds. 2014. The financial and economic crises and their impact on health and well-being. Amityville, NY: Baywood.

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                                        This provocative collection of essays uses a political-economy approach to examine the real causes of socioeconomic crises and the effects of recession, and associated austerity measures, on health and health inequalities. Recommendations for public health action are also included.

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                                        • O’Campo, Patricia, and James R. Dunn, eds. 2012. Rethinking social epidemiology. New York: Springer.

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                                          The studies included in this volume are focused on shedding light on the role of social epidemiology as an agent of change, which not only investigates the social causes of health inequalities but also suggests solutions to alleviate them, thus contributing to improved population health.

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                                          • Raphael, Dennis, ed. 2008. Social determinants of health: Canadian perspectives. 2d ed. Papers presented at the Social Determinants of Health across the Life Span conference, held in 2002 in Toronto. Toronto: Canadian Scholars.

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                                            Contains a collection of contributions from the Social Determinants of Health across the Life Span conference. This volume discusses the impact of the SDOH on population health, and it combines health, social, economic, and political perspectives.

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                                            • Rose, Geoffrey. 2008. Rose’s strategy of preventive medicine: The complete original text. Oxford: Oxford Univ. Press.

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                                              The author argues that the health of an individual can be tied back to the health of the society in which the individual lives. Using a variety of examples, the author demonstrates that effective prevention requires changes at the population level. Originally published in 1992 as The Strategy of Preventive Medicine.

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                                              • Wilkinson, Richard G. 2001. Unhealthy societies: The afflictions of inequality. London: Routledge.

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                                                Using country-specific examples, the author illustrates that unequal societies, in which the income differential is wider, experience lower life expectancy while societies with a narrower gap in income distribution benefit from higher life expectancy. Originally published in 1996.

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                                                Databases

                                                The Internet is a valuable resource for convenient access to information on the SDOH. There are numerous websites providing access to data and knowledge on various SDOH related topics, as exemplified in this section. The Social Determinants of Health website, run by the US Centers for Disease Control and Prevention, contains a vast collection of national and international resources, data reports, policy briefings, and publications. The Social Determinants of Health Network, a four-year-long collaboration project financed by the European Commission, hosts a portal to share information on SDOH research in African and Latin American countries. The European Portal for Action on Health Inequalities provides information on strategic initiatives, policies, and relevant resources on health inequalities in European countries. Explore resources on Health Equity and the Social Determinants of Health website covers a range of health equity topics and is supported by the Department of Health, University College London (UCL), and the British Medical Association. The WHO: Social Determinants of Health portal, run by the World Health Organization (WHO), contains vast sets of data and knowledge on the SDOH and is available in Arabic, Chinese, English, French, Russian, and Spanish.

                                                Journals

                                                Journals increase ease of access to vast amounts of information on many topics related to the SDOH, making it easier for students, educators, researchers, professionals, and policymakers to access knowledge and data. A journal entirely devoted to the SDOH does not exist currently, but there are numerous journals that publish articles on SDOH-related topics. This section contains a selection of such journals, grouped by targeted geographical area.

                                                Asia-Pacific

                                                The Asia Pacific Journal of Public Health includes articles on public health issues, including global health and health security. The Australasian Epidemiologist focuses on current epidemiologic research completed in Australasia and the association among epidemiology, public health, and policy. The Economic & Political Weekly is an online Indian magazine addressing multiple current issues, including safe drinking water, women’s mobility and migration, and social security.

                                                International

                                                The International Journal for Equity in Health publishes studies dedicated to health equity research, while Milbank Quarterly is dedicated to research on health-care policy. PLoS One addresses a variety of topics related to the SDOH. The International Journal of Health Services includes scientific studies, position papers, and debates on topics such as health, social policy, political economy, and sociology. The following journals cover social epidemiology and population health topics: Gaceta Sanitaria, the International Journal of Epidemiology, the Journal of Epidemiology & Community Health, and Social Science & Medicine. Health & Place publishes articles on topics related to place or location, including epidemiologic, geographical, and societal issues.

                                                Europe

                                                BMC Public Health is part of the Biomedcentral (BMC) series, a collection of sixty-five online research journals, and includes many studies focused on the SDOH. The BMJ (British Medical Journal) and the European Journal of Epidemiology also include publications on the SDOH. Both the Scandinavian Journal of Public Health and European Journal of Public Health cover topics on public health and health policy.

                                                The Americas

                                                While the American Journal of Epidemiology contains numerous articles on social epidemiology and focuses on empirical research findings and methodological approaches, the Epidemiologic Reviews journal covers review studies on health disparities and epidemiologic methods. The American Journal of Public Health commonly includes articles on social influences and SDOH, and the Journal of Public Health Policy is mainly dedicated to the advancement of healthy public policies. The Annual Review of Public Health addresses important advances in public health. Public Health Reports covers public health practice and scientific research, including focus on health disparities, occupational disease, and emerging public health issues. The Canadian Journal of Public Health / Revue Canadienne de Santé Publique reports on public health policy, epidemiology, family, and rural health.

                                                Distribution of Power, Money, and Resources

                                                Structural elements such as governance, policy, and cultural and societal norms and values play a significant role in the societal distribution of power, money, and resources. An inequitable distribution of any of these resources is linked to health inequities, as described in more detail in the eleven subsections under this heading.

                                                Income Inequality

                                                Income is recognized as a significant SDOH, and a wide range of scientific studies are dedicated to investigating the association between income and health. Various approaches to the study of income and health are included in this section. Marmot 2002 uses an epidemiologic perspective to review how income is related to health through the gross national product of nations, individual incomes, and income disparities within and between countries. Benzeval, et al. 2014 is a review of 272 studies examining the relationship between income and health, in order to inform policy efforts. Macinko, et al. 2003 presents a critical review of the literature studying the link between income inequality and health outcomes. Lynch, et al. 2004 reviews and assesses the evidence investigating the association between income inequality and health. Coburn 2004 discusses the impact of neoliberal principles on income inequality and access to resources. Wilkinson and Pickett 2009 critically analyzes current research evidence on the association between income inequality and health and social outcomes. See also Anderson, et al. 2003, cited under Housing/Homelessness; Navarro and Muntaner 2014, cited under Textbooks; Whitehead 2007, cited under General Overviews; and Wilkinson 2001, cited under Textbooks.

                                                Race/Ethnicity

                                                Race and ethnicity are often associated with disparities in health status and are thus considered to be among the SDOH. Research on ethnicity and health and that on the provision of culturally competent care are emerging fields in health care. Camara 2000 uses an inspired gardening metaphor to explain racism and suggests potential interventions to alleviate its impact on health. Krieger, et al. 2003 investigates whether area-based socioeconomic measures can be used to monitor socioeconomic gradients in health for race/ethnic and gender-diverse groups. Williams, et al. 2003 summarizes findings from existing population-level studies that investigate the associations between perceived racial/ethnic discrimination and health. The National Collaborating Centre for Aboriginal Health reports (National Collaborating Centre for Aboriginal Health 2007–) address fundamental causes of disease within aboriginal populations in Canada. New Zealand Guidelines Group 2009, a practice guideline, targets health-care providers, patients, and public health departments and makes recommendations for data collection and provision of interventions that can reduce ethnic disparities. Quiñones, et al. 2011, which contains systematic review findings, may guide future research studies and policies/programs to reduce racial health disparities. Beach, et al. 2006 shares findings on the effectiveness of interventions to enhance quality and access to care for racial/ethnic minorities, and Liu, et al. 2012 presents findings from a realist synthesis of the literature that assesses the effectiveness of health promotion interventions designed for ethnic groups. See also Navarro 1976, cited under Classic Works, and Wilkinson 2001, cited under Textbooks.

                                                Gender Equity

                                                Gender is widely accepted as being an SDOH, and the association between gender and health continues to be the focus of numerous studies conducted by scholars both in social and health sciences. One systematic review, four synthesis reports, one methods study, and a book chapter are listed in this section as examples of different angles taken in the study of gender and health. O’Campo, et al. 1995 exemplifies the use of multilevel analytic methods in gender research, and the authors argue their implications for public health. Doyal and Payne 2011, a book chapter, discusses factors that affect health inequalities across gender, and Östlin 2005 reports on evidence on the effects of health-care reforms on gender equity in health. World Health Organization 2007 synthesizes evidence from the literature on gender inequalities perpetuated by health-care systems and health research. Govender and Penn-Kekana 2007 is a review of the literature to investigate the existence of gender biases in health-care practices, and Campos-Serna, et al. 2013 presents findings from a systematic review of the literature dedicated to the study of employment conditions in relation to gender inequalities. Petchesky and Laurie 2007 synthesizes available evidence relevant to gender, health, and human rights in refugee camps.

                                                Social Capital

                                                Interest in social capital and social-capital concepts among researchers in the public health field has grown steadily since the mid-1990s. Two systematic reviews, one synthesis report, one book, and one single study are included in this section to provide an overview of publications on this field. Kawachi, et al. 2008 offers a detailed overview of research on social capital; its intended audience includes students, academics, researchers, and professionals interested in social and health sciences. Uphoff, et al. 2013 summarizes findings from a systematic review of the literature that investigates the associations between social capital and socioeconomic inequalities in health, and Vyncke, et al. 2013 presents findings from a systematic review of the literature that studies the impact of social capital on health equity. Carlson and Chamberlain 2003 synthesizes the literature that studies the association between social capital and population health, in order to identify gaps in health disparities research. Fujiwara and Kawachi 2008 shares findings from a study that examined the effect of social capital on health among twins in the United States.

                                                Social Exclusion

                                                Social exclusion related to an individual’s income, class, education, ethnicity, or other factors is a form of discrimination that prevents individuals from full participation in various aspects of the society they live in. Popay, et al. 2008 contains a review of policies and initiatives addressing social exclusion, poverty reduction or eradication, provision of novel services, and initiatives to improve access to existing services. World Health Organization 2010 contains background documents and case studies on social exclusion, poverty and health among European countries.

                                                Social Class

                                                Social class is one of the most commonly recognized SDOH, and there are numerous theories, approaches, and methods used to study the different patterns of association between social class and health. Two reports and a book chapter are mentioned in this section to familiarize the reader with this literature. Muntaner, et al. 2013, a book chapter, reviews two significant strands of sociological theories to understand potential causal pathways involved in the creation of social inequalities and concurrent mental health disparities. Department of Health and Social Security 1980, also known as the Black Report, attests to Britain’s early preoccupation with socioeconomic influences on health and mortality rates. Whitehead 1987 shines light on inequalities in health and calls for the creation of health policies that acknowledges that there are many other factors influencing health, in addition to health services. See also Hoven and Siegrist 2013, cited under Employment / Work Conditions; Marmot 2002, cited under Income Inequality; Navarro and Muntaner 2014, cited under Textbooks; and Wilkinson and Pickett 2009, cited under Income Inequality.

                                                • Department of Health and Social Security. 1980. Inequalities in health: Report of a working group chaired by Sir Douglas Black. London: Department of Health and Social Security.

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                                                  Explores the impact of socioeconomic factors on health inequalities and draws attention to differences in mortality rates among different social classes. Considers cultural/behavioral and materialistic/structuralist theories to explain the mechanisms by which social determinants affect health. Suggests that public health interventions and political action are needed to address social inequalities in health.

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                                                  • Muntaner, Carles, Edwin Ng, Christophe Vanroelen, Sharon Christ, and William W. Eaton. 2013. Social stratification, social closure, and social class as determinants of mental health disparities. In Handbook of the sociology of mental health. Edited by Carol Aneshensel, Jo C. Phelan, and Alex Bierman, 205–227. Handbooks of Sociology and Social Research. Dordrecht, The Netherlands: Springer.

                                                    DOI: 10.1007/978-94-007-4276-5Save Citation »Export Citation » Share Citation »

                                                    The authors examine two major paths of sociological theories to gain a better understanding of potential causal pathways involved in the creation of social inequalities and concurrent mental health disparities. Findings are discussed in the context of classic and modern research. Race/ethnicity and gender perspectives are also considered.

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                                                    • Prins, Seth J., Lisa M. Bates, Katherine M. Keyes, and Carles Muntaner. 2015. Anxious? Depressed? You might be suffering from capitalism: Contradictory class locations and the prevalence of depression and anxiety in the USA. Sociology of Health & Illness 37.8: 1352–1372.

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                                                      In recognizing that the indicator “socioeconomic status” (SES) does not explain patterns of depression and anxiety, the relational construct of contradictory class locations (which includes the dimensions both of ownership and labor) are examined in this study. Findings suggest that the impacts of social-class relations do extend beyond SES, and thus recommendations are made for future studies to examine the mechanisms of exploitation and domination.

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                                                      • Whitehead, Margaret. 1987. The health divide: Health education councils report. London: Department of Health and Social Security.

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                                                        Reaffirms the direct association between health and social class and states that since the publication of the Black Report, the difference in health status among people from different social-class backgrounds had continued to widen.

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                                                        Welfare State and Other Policy Approaches

                                                        The effect of the welfare state and other policy approaches on health and health equity, through action on the SDOH, has been studied by various scholars and continues to be the focus of attention for many advocacy efforts. A few synthesis reports and reviews are introduced in this section to provide the reader with a variety of perspectives on the topic. Bergqvist, et al. 2013 shares findings on the link between characteristics and health of the welfare state and health inequalities. The authors of Muntaner, et al. 2011 conducted a literature review to increase understanding of the role of political traditions/parties and characteristics of the welfare state on population health. Brennenstuh, et al. 2012 presents findings from a systematic review of the literature that investigates the use of welfare regime typologies in comparative health research, and Eikemo, et al. 2008 uses data from a European Social Survey to analyze how the degree of income-related health inequalities differs across welfare state regimes. Friel, et al. 2012 describes favorable intersectoral policies/programs underway in Asia Pacific to improve economic and social living conditions. Lundberg, et al. 2008, shares findings from an analysis of the association between (1) welfare state program characteristics and (2) infant mortality rates and old-age excess mortality. Commission on the Reduction of Social Inequalities in Health in Spain 2010 contains a wide range of recommendations to reduce health inequalities, and Mackenbach 2012 presents a theoretical analysis of nine early-21st-century theories used to explain health inequalities in modern welfare states. See also Adams, et al. 2006, cited under Health Care; Braveman, et al. 2011 and Commission on Social Determinants of Health 2008, both cited under General Overviews; Embrett and Randall 2014; cited under Methods and Tools for Research and Monitoring; Marmot 2013, cited under Global Governance; Marmot and Wilkinson 2005, cited under Textbooks; Marmot, et al. 2010, cited under General Overviews; Navarro and Muntaner 2014, cited under Textbooks; Whitehead 2007, cited under General Overviews; Raphael 2008 and Rose 2008, both cited under Textbooks; and Navarro and Shi 2001, cited under General Overviews.

                                                        Economics of the Social Determinants of Health

                                                        Systematic reviews, synthesis reports, a seminal book, and an article are included in this section, to exemplify how economic rationales may be used to advance the SDOH agenda. Navarro 2002 discusses factors contributing to the increase in social inequalities and their effect on population health. World Health Organization 2001 suggests that financial investments in health will bring about economic development and manageable population growth. Epstein, et al. 2009 shares findings from a critical analysis of the 2008 report compiled by the WHO’s Commission on Social Determinants of Health. Lucas, et al. 2009, a systematic review, investigates the impact of monetary support given to poor families, in the developed world, on the health and well-being of their children. Mackenbach, et al. 2011 estimates the economic burden of health inequalities related to socioeconomic factors, in order to add more data to the repertoire of arguments calling for joint political intervention to address health inequalities. See also Navarro and Muntaner 2014, cited under Textbooks, and Wardrip, et al. 2011, cited under Housing/Homelessness.

                                                        • Deaton, Angus. 2013. The great escape: Health, wealth, and the origins of inequality. Princeton, NJ: Princeton Univ. Press.

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                                                          The aim of this book is to provide information on health and wealth from different countries. The historical patterns of health are used as a starting point for understanding current health inequalities.

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                                                          • Epstein, David, Dolores Jimenez-Rubio, Peter C. Smith, and Marc Suhrcke. 2009. An economic framework for analysing the social determinants of health and health inequalities. York, UK: Univ. of York.

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                                                            Uses an economic framework to describe the causes and effects of health inequalities, with the purpose of informing policymaking. Methods for evaluation and priority setting are also described.

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                                                            • Lucas, Patricia, Karen McIntosh, Mark Petticrew, Helen M. Roberts, and Alan Shiell. 2009. Financial benefits for child health and well-being in low income or socially disadvantaged families in developed world countries. Evidence-Based Child Health: A Cochrane Review Journal 4.2: 1046–1134.

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                                                              Shares results from a review of studies that assess the impact of financial support, provided to disadvantaged families, on children’s health and educational achievement. On the basis of results from ten studies, the authors concluded that there were no short- to medium-term effects on child outcomes.

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                                                              • Mackenbach, Johan P., Willem J. Meerding, and Anton E. Kunst. 2011. Economic costs of health inequalities in the European Union. Journal of Epidemiology & Community Health 65.5: 412–419.

                                                                DOI: 10.1136/jech.2010.112680Save Citation »Export Citation » Share Citation »

                                                                Suggests that the financial implications of health inequalities are considerable, and, for this reason, investments in policies and interventions to reduce them make economic sense. The authors state that further research is needed to increase precision in such calculations.

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                                                                • Milanovic, Branko. 2016. Global inequality: A new approach for the age of globalization. Cambridge, MA: Belknap Press of Harvard Univ. Press.

                                                                  DOI: 10.4159/9780674969797Save Citation »Export Citation » Share Citation »

                                                                  Drawing on research that examines different nations, this book provides a theoretical explanation for global inequality. Income inequality and political issues related to inequality are discussed, including policies that may reverse the current trajectory.

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                                                                  • Navarro, Vicente, ed. 2002. The political economy of social inequalities: Consequences for health and quality of life. Amityville, NY: Baywood.

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                                                                    This volume explores factors involved in the global increase in social inequalities, and the impact of social disparities on population health and well-being. The book contains a wide and thoughtful collection of articles written by well-accomplished scholars from across the globe.

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                                                                    • Stiglitz, Joseph E. 2012. The price of inequality: How today’s divided society endangers our future. New York: W. W. Norton.

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                                                                      Using an economic analysis, the author critiques American capitalism and demonstrates that the level of inequality is perpetuated by the political process in which policy decisions support the wealthy. Macroeconomic policy changes are recommended to support the redistribution of income.

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                                                                      • Stuckler, David, and Sanjay Basu. 2013. The body economic: Why austerity kills; Recessions, budget battles, and the politics of life and death. New York: Basic Books.

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                                                                        Using case studies, the authors examine how the government policy of austerity affects heath. They conclude with evidence from various countries that austerity serves to deepen recessions, whereas public spending serves to support economic recoveries.

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                                                                        • Wolff, Richard D. 2016. Capitalism’s crisis deepens: Essays on the global economic meltdown, 2010–2014. Chicago: Haymarket.

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                                                                          In a series of essays, it is asserted that the global economic crisis of 2008 should be viewed as an evolving stage of capitalism versus an isolated period in time. This book concludes by suggesting that an alternative to capitalism or a system change is needed.

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                                                                          • World Health Organization. 2001. Macroeconomics and health: Investing in health for economic development. Geneva, Switzerland: World Health Organization.

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                                                                            Report of the Commission on Macroeconomics and Health. The evidence summarized in this report suggests that increased investments in health improvements will result in greater incomes, noticeable economic growth, and decreased population growth. The focus of the report is placed mainly on low-income countries and on the disadvantaged populations in middle-income countries.

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                                                                            Health Care

                                                                            Given that access to and use of health services is greatly affected by factors such as class, income, education, gender, and environment, a few studies on health-care services are included in this article. World Health Organization 2014 is dedicated to health system reform to facilitate universal access to care. Milton, et al. 2011 presents a synthesis of discussions from an expert group meeting, focused on conceptual and methodological challenges associated with assessing the impact of universal policies on the SDOH and health inequalities. National Research Council and Institute of Medicine 2013 investigates the reasons why Americans have lower life expectancy rates and a pattern of more health problems when compared with individuals in countries with similar incomes. Lagarde and Palmer 2006 is a review of the potential effects of various health-financing policy options on improving access to health care for poor people. Acharya, et al. 2012 presents the results of a systematic review of the evidence assessing the impact of health insurance on socioeconomically disadvantaged populations. Doherty and Govender 2004 synthesizes the evidence in order to assess cost-effectiveness of primary-care interventions. Adams, et al. 2006 is a systematic review that investigates the impact of welfare rights advice, given in health-care institutions, on the health and socioeconomic status of individuals. Willey, et al. 2013 is a systematic review that was conducted to evaluate the effectiveness of interventions meant to improve health services provided by frontline professionals.

                                                                            Globalization and Migration

                                                                            Numerous scientific studies continue to investigate the link between globalization and migration patterns and health and health inequalities. In this section, three synthesis reports and two books are introduced, with the purpose of familiarizing the reader with a variety of approaches used to study globalization and health. Lee, et al. 2002 explores ways through which health policymaking is affected by globalization. Labonte and Schrecker 2006 synthesizes large amounts of evidence on the topic of globalization and health, and Globalisation Knowledge Network 2011 presents synthesized evidence on health equity and globalization. Catalan Agency for Health Technology Assessment and Research 2004 presents findings from a review of the evidence on national strategies used to address immigrant health issues. See also Navarro and Muntaner 2014, cited under Textbooks.

                                                                            • Catalan Agency for Health Technology Assessment and Research. 2004. Experiences in research and policies related to health and migration in European countries: The case of the Netherlands, the United Kingdom and Switzerland. Barcelona: Catalan Agency for Health Information, Assessment and Quality.

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                                                                              Presents findings from a review of the evidence on national strategies used to conduct research and provide care for immigrants in three European countries: Netherlands, the United Kingdom, and Switzerland. The purpose of the study is to identify relevant approaches that could be implemented in Catalonia, Spain, to address immigrant health issues. Report published in Spanish. Summary available in English.

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                                                                              • Labonté, Ronald, Chantal Blouin, Mickey Chopra, et al. 2011. Globalisation Knowledge Network. Towards health-equitable globalisation: Rights, regulation and redistribution. Ottawa, ON: Institute of Population Health, Univ. of Ottawa.

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                                                                                Final report to the Commission on Social Determinants of Health. The authors examine the role played by globalization in increasing health inequities and associated challenges. The pathways through which globalization affects health equity are described in detail, including political implications. Seven compelling country-specific case studies are also included.

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                                                                                • Labonté, Ronald, Katia Mohindra, and Ted Schrecker. 2011. The growing impact of globalization for health and public health practice. Annual Review of Public Health 32:263–283.

                                                                                  DOI: 10.1146/annurev-publhealth-031210-101225Save Citation »Export Citation » Share Citation »

                                                                                  Using a political-science perspective, this article discusses different globalization-related pathways to health and concludes with a call for governments to consider global health and its social determinants to be in all foreign policies.

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                                                                                  • Labonte, Ronald, and Ted Schrecker. 2006. Globalization and social determinants of health: Analytic and strategic review paper. Ottawa, ON: Institute of Population Health, Univ. of Ottawa.

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                                                                                    Discusses ways in which globalized economic and political environments can promote or threaten health, through the SDOH. Examines approaches that can counteract such effects and, thus, improve the health of populations.

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                                                                                    • Lee, Kelley, Kent Buse, and Suzanne Fustukian, eds. 2002. Health policy in a globalising world. Cambridge, UK: Cambridge Univ. Press.

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                                                                                      Significant issues such as trade agreements, private-public partnerships, privatization, regulation, cost-effectiveness and priority setting, emerging health epidemics, aging, and humanitarian efforts are discussed in the context of public health, population health, and health policy.

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                                                                                      • Pogge, Thomas. 2010. Politics as usual: What lies behind the pro-poor rhetoric. Cambridge, UK: Polity.

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                                                                                        This book makes the case that poverty and oppression are pervasive and that policies implemented by affluent states and international organizations knowingly contribute to political and economic inequalities.

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                                                                                        • Schrecker, Ted, and Clare Bambra. 2015. How politics makes us sick: Neoliberal epidemics. Basingstoke, UK: Palgrave Macmillan.

                                                                                          DOI: 10.1057/9781137463074Save Citation »Export Citation » Share Citation »

                                                                                          Using a political-economy approach and evidence related to social determinants of health, the authors examine the effect of policies such as privatization, market deregulation, and austerity on global population health. They assert that a shift toward structural social policies that are consistent with a social-democratic welfare state approach (Scandinavian countries) is warranted.

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                                                                                          • Smith, Katherine E., Clare Bambra, and Sarah E. Hill, eds. 2016. Health inequalities: Critical perspectives. Oxford: Oxford Univ. Press.

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                                                                                            With widening health inequalities occurring, current research and policies are examined with the aim toward identifying contrasting views from which to generate evidence and inform social policies. Chapters include a discussion on political policies of neoliberalism and austerity and its connection to health inequalities.

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                                                                                            Global Governance

                                                                                            In light of political, economic, and cultural systems around the world being increasingly interconnected, there is a reasonable drive toward shared worldwide governance on issues affecting more than one country or area. One of the topics requiring coordination of efforts on the global arena, in addition to regional and national initiatives, is the reduction of health inequities within and among countries. A few synthesis reports are included in this section to summarize a number of global governance strategies. McQueen, et al. 2012 explores available evidence on governance structures that are most effective in addressing the SDOH, while Brown and Harrison 2013 analyzes key characteristics of governance systems that have increased potential for success in reducing health inequities. UNICEF 2010 presents an overview of relevant data in order to track progress on the achievement of the eight Millennium Development Goals (MDGs) set by the UN in 2000. UN Millennium Project 2005 reviews key strategic priorities in achieving the MDGs; these priorities overlap greatly with those of the SDOH strategies in their shared goals to eliminate poverty, improve health and living conditions, and promote access to education, gender equality, and environmental sustainability. The comprehensive study in Marmot 2013 focuses on inequalities in health among member states of the European Union. Kawachi and Wamala 2006 provides a detailed analysis of the role of international institutions in dealing with health threats associated with globalization, including socioeconomic inequalities, infectious diseases, climate change, tobacco use, and obesity. UN Development Programme 2011 synthesizes evidence on environmental sustainability and equity, arguing that both challenges are closely linked and have to be addressed together.

                                                                                            • Brown, Chris, and Dominic Harrison. 2013. Governance for health equity in the WHO European region. Copenhagen: World Health Organization Regional Office for Europe.

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                                                                                              Offers an analysis of policies and strategies to address the SDOH and health inequities and explores why some interventions are successful while others are not. Shares a systems worksheet meant to support governmental action on health equity through SDOH approaches.

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                                                                                              • Davies, Sara E. 2010. Global politics of health. Cambridge, UK: Polity.

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                                                                                                Taking an international-relations approach, this book seeks to explore the relationship between politics and health. Central aims include highlighting current global public health issues that require greater attention and recommending directions for future studies.

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                                                                                                • Karan, Abraar, and Geeta Sodhi, eds. 2015. Protecting the health of the poor: Social movements in the South. CROP International Studies in Poverty Research. London: Zed Books.

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                                                                                                  Drawing on research from Africa, Asia, and Latin America, this book examines health care from the local to global level. Social, legal, and political factors are examined to argue for a comprehensive strategy to protect the health of the poor.

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                                                                                                  • Kawachi, Ichiro, and Sarah Wamala, eds. 2006. Globalization and health. New York: Oxford Univ. Press.

                                                                                                    DOI: 10.1093/acprof:oso/9780195172997.001.0001Save Citation »Export Citation » Share Citation »

                                                                                                    This volume provides a thorough analysis of health threats associated with globalization. It also reviews the role of international organizations such as the WHO, the World Bank, and the International Monetary Fund in addressing globalization issues, since these institutions are inherently linked to public health.

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                                                                                                    • Leon, Joshua K. 2015. The rise of global health: The evolution of effective collective action. Albany: State Univ. of New York Press.

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                                                                                                      Current public health regimes are viewed as increasingly complex, resulting in new challenges for the role of global health governance in addressing population health issues. The aim of this book is to provide an understanding of global governance in order to support collective action among decentralized nonstate actors.

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                                                                                                      • Marmot, Michael. 2013. Review of social determinants and the health divide in the WHO European region: Final report. Copenhagen: World Health Organization, Regional Office for Europe.

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                                                                                                        This synthesis report provides several examples of initiatives that address the SDOH. Based on global evidence, it proposes various policies to support the goal of reducing health inequities within and between countries. Also available in Russian.

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                                                                                                        • McQueen, David V., Matthias Wismar, Vivian Lin, Catherine M. Jones, and Maggie Davies, eds. 2012. Intersectoral governance for health in all policies: Structures, actions and experiences. Observatory Studies 26. Copenhagen: World Health Organization, Regional Office for Europe.

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                                                                                                          Emphasizes the close ties between the principles of “health in all policies” and the SDOH approaches. Restates the key role played by public health in the creation of healthy public policies that address systemic factors influencing health.

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                                                                                                          • UNICEF. 2010. Progress for children: Achieving the MDGs with equity. Progress for Children 9. New York: UN Children’s Fund.

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                                                                                                            Upon assessment of progress on the achievement of the MDGs, the report concludes that while some countries are successful in achieving these goals, others are lagging behind and thus maintain health disparities.

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                                                                                                            • UN Development Programme. 2011. Human development report 2011: Sustainability and equity; A better future for all. New York: UN Development Programme.

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                                                                                                              Provides strategies to promote environmental sustainability and equity at local, regional, national, and international levels. Accountability, public participation, international financing for development, and environmental audits are emphasized.

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                                                                                                              • UN Millennium Project. 2005. Investing in development: A practical plan to achieve the Millennium Development Goals. London: Earthscan.

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                                                                                                                Contains a detailed overview of the MDGs and their significance, then-recent achievements, and a summary of key challenges, as well as politico-economic priorities to achieve the MDGs both at national and international levels.

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                                                                                                                • World Health Organization. 2015. Health in 2015: From MDGs (Millennium Development Goals) to SDGs (Sustainable Development Goals). Geneva, Switzerland: World Health Organization.

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                                                                                                                  This document builds on an outcome document from a UN conference on sustainable development. It provides a summary of progress made on MDGs and provides seventeen Sustainable Development Goals (SDGs), which comprise a broad range of economic, social, and environmental objectives for the next fifteen years (to 2030).

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                                                                                                                  Daily Living Conditions

                                                                                                                  The conditions of daily life include circumstances related to the early years, access to educational opportunities, employment and working conditions, housing, and the surrounding environment. All these are crucial elements that affect people’s health.

                                                                                                                  Early Child Development / Youth Health

                                                                                                                  The effect of early child development on health is increasingly acknowledged by scholars and health professionals. Evidence describing this association is introduced in this section, as derived from one practice guideline, four systematic reviews, and two synthesis reports. Hahn, et al. 2014 is a systematic review that assesses the impact of full-day kindergarten on children in low-income and ethnic communities. Reiss 2013, a systematic review, investigates the link between socioeconomic inequalities and mental health problems in children and adolescents. Sellström and Bremberg 2006 summarizes the results of a systematic review of multilevel studies assessing the effect of neighborhood characteristics on child and adolescent health. Irwin, et al. 2007 synthesizes data about interventions to improve early child development globally, and Langford, et al. 2014 presents the results of a systematic review meant to assess the effectiveness of school-based interventions on improving young people’s health. National Institute for Health and Clinical Excellence 2008, a practice guideline, presents recommendations to support nutrition improvements for mothers and children in low-income families. See also Vyncke, et al. 2013, cited under Social Capital.

                                                                                                                  • Hahn, Robert A., Veda Rammohan, Benedict I. Truman, et al. 2014. Effects of full-day kindergarten on the long-term health prospects of children in low-income and racial/ethnic-minority populations: A community guide systematic review. American Journal of Preventive Medicine 46.3: 312–323.

                                                                                                                    DOI: 10.1016/j.amepre.2013.12.003.Save Citation »Export Citation » Share Citation »

                                                                                                                    Presents the results of a meta-analysis measuring the health effects on US children of full-day kindergarten compared with half-day kindergarten. The available evidence supports full-day kindergarten for its potential to promote health equity when focused on low-income and minority populations.

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                                                                                                                    • Irwin, Lori G., Arjumad Siddiqi, and Clyde Hertzman. 2007. Early child development: A powerful equalizer; Final report for the World Health Organization’s Commission on Social Determinants of Health. Vancouver, BC: Human Early Learning Partnership.

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                                                                                                                      Findings indicate that parents, caregivers, family, and community are key influencers for child development. Given that typically they cannot provide supportive environments on their own, support from local, regional, national and international organizations, and government is required.

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                                                                                                                      • Langford, Rebecca, Christopher P. Bonell, Hayley E. Jones, et al. 2014. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database of Systematic Reviews 4:CD008958.

                                                                                                                        DOI: 10.1002/14651858.CD008958.pub2Save Citation »Export Citation » Share Citation »

                                                                                                                        The evidence collected through this review suggests that school-based interventions can improve certain aspects of health, but there isn’t enough evidence to assess their effectiveness for other health conditions.

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                                                                                                                        • National Institute for Health and Clinical Excellence. 2008. Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households. London: National Institute for Health and Clinical Excellence.

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                                                                                                                          Provides information on the effectiveness/cost-effectiveness of interventions to improve nutrition of pregnant women, breastfeeding mothers, and infants and children in low-income households. It is intended for nurses, dieticians, physicians, pharmacists, social workers, and public health departments.

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                                                                                                                          • Reiss, Franziska. 2013. Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine 90 (August): 24–31.

                                                                                                                            DOI: 10.1016/j.socscimed.2013.04.026.Save Citation »Export Citation » Share Citation »

                                                                                                                            According to an analysis of fifty-five included studies, children and adolescents from a disadvantaged socioeconomic status are more likely to develop mental health problems. Findings conclude that due to increased variation in the methodology used to assess socioeconomic status, international comparisons are difficult to complete.

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                                                                                                                            • Sellström, Eva, and Sven Bremberg. 2006. Review article: The significance of neighbourhood context to child and adolescent health and well-being; A systematic review of multilevel studies. Scandinavian Journal of Public Health 34.5: 544–554.

                                                                                                                              DOI: 10.1080/14034940600551251.Save Citation »Export Citation » Share Citation »

                                                                                                                              According to this review, on average, approximately 10 percent variation in child health outcomes can be attributed to neighborhood socioeconomic status and social climate, after controlling for individual and family variables.

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                                                                                                                              Education

                                                                                                                              The relationship between education and health continues to be studied and documented by health scientists, epidemiologists, sociologists, and economists. Different approaches and methodologies are used to study causality, strength, and the direction of this association. One systematic review and three synthesis reports are introduced in this section. The meta-analysis in Baker, et al. 2011 is dedicated to understanding the link between education and improved health outcomes. Mäki, et al. 2013 investigates socioeconomic variability in disability-free life expectancy in eight countries in Europe at the beginning of the 21st century. Cutler and Lleras-Muney 2006 discusses the link between education and health, as related to income, access to health care, access to the labor market, and social networks. World Health Organization 2011, a policy briefing on education, reviews health benefits linked to education as well as strategies, barriers, and potential collaborations to advance educational goals. UNESCO 2014 presents an update on the global achievement of education goals and shares strategies to improve quality of teaching.

                                                                                                                              • Baker, David P., Juan Leon, Emily G. Smith Greenaway, John Collins, and Marcela Movit. 2011. The education effect on population health: A reassessment. Population and Development Review 37.2: 307–332.

                                                                                                                                DOI: 10.1111/j.1728-4457.2011.00412.xSave Citation »Export Citation » Share Citation »

                                                                                                                                Twenty-nine studies are included in this systematic review. Key objectives are to assess the causal link between education and population health, document the strength of the effect of education on health, and introduce the hypothesis that this association may be explained by the development of cognitive skills of reasoning.

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                                                                                                                                • Cutler, David M., and Adrian Lleras-Muney. 2006. Education and health: Evaluating theories and evidence. Working Paper 12352. Cambridge, MA: National Bureau of Economic Research.

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                                                                                                                                  Provides a review of the evidence linking education and health and considers various aspects of this relationship, such as income and access to health care, access to the labor market, information and cognitive skills, social networks, and so on. Policy implications are also discussed.

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                                                                                                                                  • Mäki, Netta, Pekka Martikainen, Terje Eikemo, et al. 2013. Educational differences in disability-free life expectancy: A comparative study of long-standing activity limitation in eight European countries. Social Science & Medicine 94 (October): 1–8.

                                                                                                                                    DOI: 10.1016/j.socscimed.2013.06.009Save Citation »Export Citation » Share Citation »

                                                                                                                                    Europeans with a higher level of education have a higher life expectancy and more disability-free years than Europeans with lower education. In southern Europe, the health impact of educational differences is the smallest, while in eastern and northern Europe it is the largest.

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                                                                                                                                    • UNESCO. 2014. Teaching and learning: Achieving quality for all. EFA Global Monitoring Report 2013/4. Paris: UN Educational, Scientific and Cultural Organization, EFA Global Monitoring Report Team.

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                                                                                                                                      Presents compelling arguments to make education a priority on the global development agenda. Provides an update on international progress made toward the achievement of educational goals. It provides strategies for recruiting high-quality teachers.

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                                                                                                                                      • World Health Organization. 2011. Education: Shared interests in well-being and development. Social Determinants of Health Sectoral Briefing Series 2. Geneva, Switzerland: World Health Organization.

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                                                                                                                                        Summarizes health benefits associated with education, challenges facing policymakers, existing strategies to address such challenges, and prospective collaborations between health and education.

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                                                                                                                                        Employment / Work Conditions

                                                                                                                                        Both employment and work conditions are widely accepted as social factors influencing health. Four systematic reviews, one synthesis report, and two reviews are introduced in this section to highlight various perspectives. World Health Organization 2007 provides a detailed analysis of how employment conditions affect various populations and how this information can be used to advocate for reductions in health inequalities through policy changes. Joyce, et al. 2010 shares results from a systematic review of the literature that studies the link between flexible working conditions and employee health. The authors of McLeod, et al. 2012 conducted a review of work-related health inequalities and analyzed the results of two comparative studies of unemployment and health. Hoven and Siegrist 2013 is a systematic review that analyzes the effect of unfavorable work and employment conditions on social inequalities in health, and Quinlan, et al. 2001 is a review of studies that investigate the link between precarious employment in industrialized societies and employee health/safety. Nieuwenhuijsen, et al. 2010 summarizes the results of a systematic review conducted to assess the contribution of work-related psychosocial risk factors to stress-related disorders (SRDs). Stansfeld and Candy 2006 presents the results of a meta-analysis of studies on psychosocial work stressors and mental health conditions. See also Campos-Serna, et al. 2013, cited under Gender Equity; Engels 1993, cited under Classic Works; Navarro and Muntaner 2014, cited under Textbooks; and Marmot, et al. 1978, cited under Classic Works.

                                                                                                                                        Environment

                                                                                                                                        The environment is a key SDOH, known to influence health through exposure and by shaping behaviors. A systematic review and three synthesis reports are presented in this section. World Health Organization 2010, a synthesis, provides a summary of evidence on the relationship between social and gender inequalities and environmental health risks. Knowledge Network on Urban Settings 2007 synthesizes knowledge about the SDOH in urban areas and offers examples of effective strategies for attaining health equity. World Health Organization 2012 emphasizes the importance of human health as a vital consideration for sustainable development and advocates for coordination of efforts to address global environmental challenges. The systematic review conducted in Bouzid, et al. 2013 presents synthesized data on the effectiveness of public health environmental interventions. See also Lalonde 1974, cited under Introductory Works.

                                                                                                                                        Housing/Homelessness

                                                                                                                                        The literature dedicated to investigating the link between housing and health is vast, and many different perspectives exist. A combination of systematic reviews, reviews, and single studies are used in this section to exemplify research in this field. Gibson, et al. 2011 introduces evidence on the effect of housing on health and health inequalities. Thomson, et al. 2013 reviews the literature to assess the health effects of improvements to physical characteristics of houses, while Dunn, et al. 2006 analyzes existing gaps and future needs for research studying the interactions among housing, socioeconomic status, and health. Wardrip, et al. 2011 summarizes evidence on the literature that addresses the link between affordable housing and socioeconomic indicators. Turley, et al. 2013 shares findings from a systematic review exploring the impact of slum-upgrading strategies on health, life quality, and socioeconomic well-being, while Stergiopoulos, et al. 2012 reports on findings from an original housing intervention, meant to address the needs of homeless ethno-racial populations who suffer from mental illness. Fitzpatrick-Lewis, et al. 2011 presents evidence on interventions to improve the health and housing status of homeless people, Anderson, et al. 2003 assesses the effectiveness of housing programs designed to provide affordable housing and reduce residential segregation, and Hwang, et al. 2009 investigates mortality rates among homeless and marginally housed people in Canada. See also Braubach, et al. 2011, cited under Methods and Tools for Research and Monitoring

                                                                                                                                        Methods and Tools for Research and Monitoring

                                                                                                                                        There is a wide range of approaches and tools used to assess the impact of the SDOH on health and health inequalities. This is not surprising, given the complex nature of the SDOH and the numerous scientific fields preoccupied with their analysis. One systematic review, one synthesis report, two guides, three books, and one single study are introduced in this section to provide a snapshot of SDOH methodological approaches. Krieger 2011 is mainly focused on epidemiologic theory; the author expands on her previous seminal study “Epidemiology and the Web of Causation: Has Anyone Seen the Spider?” published in 1994 (Social Science & Medicine 39.7: 887–903). Oakes and Kaufman 2017 provides a meticulous and comprehensive overview of the methods employed by social epidemiology. This book is a detailed resource for epidemiology students and educators, as well as public health and medical professionals and researchers. The systematic review findings in Embrett and Randall 2014 indicate that policy analysis theory is scarcely used in health equity policy research. Oliver, et al. 2008 assesses the availability and typology of health promotion and public health research focused on investigating health inequalities in young people. Blas, et al. 2011 emphasizes the role of ongoing evaluation and program adjustments and describes successful/unsuccessful approaches and lessons learned while implementing public health programs addressing the SDOH. Mendell, et al. 2012 is a guide intended for public health professionals interested in enhancing their approaches to addressing health equity and the SHOH. Braubach, et al. 2011 uses European data to outline potential methods for the assessment of housing impacts on health, through the use of twelve risk factors. Diez-Roux, et al. 1997 investigates the relationships among neighborhood characteristics, rates of coronary heart disease, and risk factors. See also Bergqvist, et al. 2013, cited under Welfare State and Other Policy Approaches; O’Campo, et al. 1995, cited under Gender Equity; and O’Campo and Dunn 2012, cited under Textbooks.

                                                                                                                                        Evaluation

                                                                                                                                        Given shrinking health-care budgets and competing priorities, the use of evaluation methods and protocols to assess effectiveness of interventions focused on the SDOH is vital. Diverse methods and approaches to evaluation are introduced in this section. Sanson-Fisher, et al. 2007 discusses challenges related to conducting evaluations of population-level interventions. Welch, et al. 2010 shares findings from a systematic review conducted to understand how the effects of interventions on health equity are assessed. National Collaborating Centre for Determinants of Health 2012 presents evidence on the effectiveness of intersectoral action on the SDOH. McPheeters, et al. 2012 reports on results from a review of quality improvement interventions for health inequalities. See also Bambra, et al. 2010, cited under General Overviews, and Epstein, et al. 2009, cited under Economics of the Social Determinants of Health

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