Tuesday, September 22, 2009

Social determinants of health

It may be intuitive to those who are public health-minded, but one's environment influences one's health. Social determinants of health has a large body of literature, and this post will attempt to summarize it.

According to the WHO, the social determinants of health are "the conditions in which people are born, grow, live, work and age, including the health system." A person's circumstances heavily influences his or her health status as well as overall health inequities.

Recently, the NYTimes and the Robert Wood Johnson Foundation reported that "research suggests social circles influence public health behaviors." For example, one study cited in the article found that a person's risk of obesity increased by 10% when a friend gained weight. According to this pie chart, lifestyle can determine up to 51% of one's health. If that lifestyle is centered around unhealthy environments and behaviors, influenced by one's surroundings, we can improve health drastically by changing one's surroundings.

This image, from the Commission on Social Determinants of Health's final report, illustrates the relationship between determinants of health and health inequities. The report says, "the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries." This Commission called for three areas of action: to tackle the daily living conditions in which people are born, grow, live, work and age; to tackle the structural drivers of those conditions at global, national and local levels; and to carry out more research to measure the problem, evaluate action and increase awareness.

There are several reasons and theories of why socioeconomic status (SES) influences health so heavily. I won't detail them in this posting as there are many articles that do so quite well (try here and here). Included in the theories are reasons of income disparities, social capital, racial discrimination, access to medical care, social support, and more. Lifestyle and physical environment causes may explain many of these issues; these two factors point to broader cultural and social trends that construct a framework in which health may be 'doomed' to be poor.

There are numerous articles citing the lack of healthy eating options, sidewalks, and safe neighborhoods for poor communities. Driving in Atlanta, this situation is abuabundantly clear. The nice neighborhoods have great grocery stores, walkable sidewalks, and overall lovely atmospheres; in contrast, the poorer neighborhoods have small and dingy grocery stores, unwalkable streets, and rundown atmospheres. These poor environments are not conducive to healthy eating or physical activity, but perhaps more importantly they may make it difficult to have a happy and meaning life with high social capital and support, crucial to overall well-being.

In sum, there are a number of factors beyond genetic makeup and personal behaviors that determine health status. These factors are crucial for public health to address in order to improve the population's health.


  1. Lauren,

    Thanks for posting this overview. While the social determinants of health may be intuitive to readers of this site, we need a broad, ongoing awareness campaign to challenge conventional wisdom that health = health care. The RWJF and WHO Commission you menton, and several others like www.unnaturalcauses.org, are helping in this regard.

    Our work in communities around the country also tells us that even when people initially grasp the idea of social determinants, it is much more difficult to sustain awareness in a way that leads to relevant action. There is progress, however, when communities come together to discover for themselves what really matters to health and what can be done together to improve it. We welcome all to join the dialogue on our site (www.communitiesofhealth.org).

    Rick Brush

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