Health Determinants

FRANK FRATICELLI, CHRMP, PHD, MPHE

 The Social Determinants of Health: The Role of Culture,
Ethnicity and Social Status

• Goal: Introduce current theories on the social

determinants in health.
• Objectives:
– a. Define social determinants of health.
– b. Discuss the role of population-level determinants on
the health status and health care of individuals and
populations.
Many factors combine to affect the health of individuals and
communities
(Heiman & Artiga, 2015)
 Introduction
• Poor health status, disease risk factors, and limited access to health care are
often interrelated and have been reported among persons with social,
economic, and environmental disadvantages (CDC, 2013).
• According to WHO, “the social determinants of health are mostly
responsible for health inequities the unfair and avoidable differences in
health status seen within and between countries”, (CDC, 2013).
 What are social determinants of health?
Healthy People 2030 ([Link]

• Social Determinants of Health (SDOH)

– are the conditions in the environments where people are
born, live, learn, work, play, worship, and age that affect a
wide range of health, functioning, and quality-of-life
outcomes and risks
 What are social determinants of health?
WHO, (2022). Social determinants of health
([Link]

• Are the non-medical factors that influence health outcomes.

• They are the conditions in which people are born, grow, work, live, and age, and
the wider set of forces and systems shaping the conditions of daily life.

• These forces and systems include economic policies and systems, development
agendas, social norms, social policies and political systems.
 Definition
• The term social determinant of health is often used to refer
broadly to any nonmedical factors influencing health,
including health-related knowledge, attitudes, beliefs, or
behaviors (such as smoking) (Braveman, Egerter & Williams, 2011).
 Education Access and Health Care Access and
Quality Quality

Neighborhood and Built

Economic Stability Environment

Healthy People 2030 ([Link] Social and Community Context

and-data/social-determinants-health)
 What are social determinants of health?
Healthy People 2030 ([Link]

• 5 domains

• 1) Economic Stability

– In the United States, 1 in 10 people live in poverty, and many people can’t
afford things like healthy foods, health care, and housing.

– People with steady employment are less likely to live in poverty and more
likely to be healthy, but many people have trouble finding and keeping a job.
 What are social determinants of health?
Healthy People 2030 ([Link]

• 2) Education Access and Quality

– People with higher levels of education are more likely to be healthier and live
longer.

• 3) Health Care Access and Quality

– About 1 in 10 people in the United States don’t have health insurance.

– People without insurance are less likely to have a primary care provider, and they
may not be able to afford the health care services and medications they need.
 What are social determinants of health?
Healthy People 2030 ([Link]

• 4) Neighborhood and Built Environment

– The neighborhoods people live in have a major impact on their health and well-
being

– Many people in the United States live in neighborhoods with high rates of
violence, unsafe air or water, and other health and safety risks. Racial/ethnic
minorities and people with low incomes are more likely to live in places with
these risks.
 What are social determinants of health?
Healthy People 2030 ([Link]

• 5) Social and Community Context

– People’s relationships and interactions with family, friends, co-workers, and

community members can have a major impact on their health and well-being.

– Many people face challenges and dangers they can’t control — like unsafe
neighborhoods, discrimination, or trouble affording the things they need. This can
have a negative impact on health and safety throughout life.

– Positive relationships at home, at work, and in the community can help reduce
these negative impacts.
 What are social determinants of health?
Healthy People 2030 ([Link]

• Social determinants of health (SDOH) have a major impact on people’s health, well-
being, and quality of life.
• Examples
• Safe housing, transportation, and neighborhoods
• Racism, discrimination, and violence
• Education, job opportunities, and income
• Access to nutritious foods and physical activity opportunities
• Polluted air and water
• Language and literacy skills
 What are social determinants of health?
Healthy People 2030 ([Link]

• Also contribute to wide health disparities and inequities.

• Example
– People who don't have access to grocery stores with healthy foods are
less likely to have good nutrition.
– That raises their risk of health conditions like heart disease, diabetes, and
obesity and even lowers life expectancy relative to people who do have
access to healthy foods.
 What are social determinants of health?
WHO (2019). Determinants of health. [Link]

• The determinants of health include:

• the social and economic environment

• the physical environment

• the person’s individual characteristics and behaviors

 What are social determinants of health?
WHO (2019). Determinants of health. [Link]

• The determinants of health include:

• Culture - customs and traditions, and the beliefs of the family and community
all affect health.
• Genetics - inheritance plays a part in determining lifespan, healthiness and the
likelihood of developing certain illnesses.
• Personal behavior and coping skills balanced eating, keeping active, smoking,
drinking, and how we deal with life’s stresses and challenges all affect health.
• Gender - Men and women suffer from different types of diseases at different
ages.
 Factors that contribute to a person's current state of health (CDC, 2013)
• Scientists generally recognize five determinants of health of a population:

– Biology and genetics

• Examples: sex and age
– Individual behavior
• Examples: alcohol use, injection drug use (needles), unprotected sex, and smoking
– Social environment
• Examples: discrimination, income, and gender
– Physical environment
• Examples: where a person lives and crowding conditions
– Health services
• Examples: Access to quality health care and having or not having health insurance
 What are health inequities or inequalities?
• Social and economic conditions and their effects on people’s lives
determine their risk of illness and the actions taken to prevent them
becoming ill or treat illness when it occurs (WHO, 2008).
• Social inequality in health will always exist and is defined by a systematic
relationship between people’s social position and their health (Diderichsen, Andersen,
& Manuel, 2011).
 Social determinants of Health
• Social determinants of health are among the key factors affecting the pathogenesis
of diseases (Davoudi Monfared et al, 2017).
• Despite the advances in diagnostic and therapeutic techniques, social determinants
of health still affect the prevalence of diseases and the related morbidity and
mortality.
• In 2008, the WHO Commission on Social Determinants of Health (CSDH),
provided compelling evidence that the most powerful drivers of health and health
inequities are the social conditions in which people are born, grow up, live, and
work (Henschke et al, 2017).
 Social determinants of Health
• Social determinants of health refer to both specific features of and
pathways by which societal conditions affect health and the potentially can
be altered by informed action (Hosseini Shokouh, 2014).
• Life enhancing resources, such as food supply, housing, economic and
social relationships, transportation, education and health care, whose
distribution across populations effectively determines length and quality of
life (CDC, 2008).
 Health inequalities (Diderichsen, Andersen, & Manuel, 2011)

• Three types of determinants that generate

health inequality
• Early determinants that affect social position and health
– 1. Early childhood development – cognitive, emotional,
social
– 2. Schooling – school completion
– 3. Segregation and the local community
• Determinants of illness influenced by social position
Determinants generating unequal consequences of
– 4. Income – poverty
illness
– 5. Longstanding unemployment 11. Health services utilization
– 6. Social marginalization 12. The exclusionary labour market
– 7. Physical environment
– 8. Work environment – ergonomic and psychosocial
– 9. Health behavior 10. Early functional decline
Heiman & Artiga (2015)
Heiman & Artiga (2015)
 Conclusion
• The social determinants of health as well as race and ethnicity,
sex, sexual orientation, age, and disability all influence health.
Identification and awareness of the differences among
populations regarding health outcomes and health
determinants are essential steps towards reducing disparities in
communities at greatest risk (CDC, 2013).
• Disparities exist when differences in health outcomes or health
determinants are observed between populations.
 References
• Braveman, P., Egerter, S. & Williams, D. (2011). The Social Determinants of Health: Coming of Age. Annu. Rev. Public Health; 32:381–98
• Braveman, P. & Gottlieb, L. (2014). The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Reports,
Supplement 2 (129); pp. 19-31
• CDC (2013). CDC Health Disparities and Inequalities Report. Morbidity and Mortality Weekly Report. Supplement; 62(3).
• Davoudi Monfared, E., Mohseni, M, Amanpour, F., Mosavi Jarrahi, A., Moradi Joo, M. & Ali Heidarnia, M. (2017). Relationship of Social
Determinants of Health with the Three-year Survival Rate of Breast Cancer. Asian Pac J Cancer Prev, 18 (4), 1121-1126.
DOI:10.22034/APJCP.2017.18.4.1121
• Diderichsen, F., Andersen, I & Manuel, C. (2011). Health Inequality - determinants and policies. Danish review on social determinants of health.
Documento recuperado de: [Link]
• Heiman, J. & Artiga, S. (2015). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Documento
recuperado de: [Link]
equity/
• Hosseini Shokouh, SM, Arab, M., Emamgholipour, S., Rashidian, A., Montazeri, A., Zaboli, R. (2014). Conceptual Models of Social Determinants of
Health: A Narrative Review. Iran Journal of Public Health; 46(4), pp.435-446
• Martínez, R., K. Thielmann, M. Bormey. (2012). Determinantes individuales y sociales de salud en la medicina familiar. Revista Cubana de Salud
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• WHO, (2008). Social determinants of health. Key Concepts. Documento recuperado de:
[Link]