11/14/24, 10\:40 AM The Social Determinants of Health

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Determinants of health\: factors that contribute to an individual's expected health; can be positive or negative.
Social determinants\: conditions in which we are born, grow, are educated, work, and live.
Dahlgren and Whitehead model\: illustrates determinants of health in layers
Political determinants\: laws or political situations can bene
Commercial determinants\: advertising in
health in children.
Environmental determinants\: living in areas with natural disasters, high pollution, or extreme climates a
access to healthcare.
Cultural determinants\: cultural perceptions of health can a
Education\: higher education levels are associated with better health through knowledge and higher-paying jobs with
bene
Healthcare services\: quality, accessibility, and a
managing health needs.
Work environment\: high-stress jobs with low control are linked to higher stress levels and related health conditions.
Housing\: poor quality housing can lead to respiratory conditions, mental health issues, infectious disease spread;
homelessness impacts physical and mental health.
Social networks\: strong social networks provide emotional and practical support, reducing depression, hypertension, heart
disease, and unhealthy behaviors.
Community cohesion\: communities with trust and control over circumstances have better health outcomes and lower
violence rates.
Health behaviors\: smoking, drinking, hand washing, and diet a
Control over health decisions\: in
health.
Sex/gender\: in
Age\: certain conditions (e.g., dementia, heart disease) are more common in older age; extremes of age a
access.
Ethnicity\: BME groups in the UK have worse health outcomes; socio-economic position and service inequalities contribute
to disparities.
Genetics\: in
Understanding determinants of health allows for targeted health promotion interventions and stronger patient
relationships.
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Introduction

The purpose of this article is to introduce the concept of ‘determinants’ of health and to understand how di
of life experience contribute to an individual’s expected health during their lifetime. Determinants can result in positive or
negative impacts on health.
The social determinants of health are the conditions in which we are born, grow up, are educated, work, and live our lives.
Understanding the determinants of health helps us to see that individual decisions play only a small part in what makes
someone healthy.
Health can be determined by factors at di
known ‘rainbow’ model, which divides determinants into layers (Figure 1).
1
Figure 1. The Dahlgren and Whitehead model of the social determinants of
health.
2

General socio-economic, cultural and environmental conditions

Political determinants
Particular laws passed, or political parties supported, will bene
countries which are sites of political con
related injuries or mental health issues, or indirectly through lack of healthcare provision or di
facilities for safety reasons.
Commercial determinants
The advertising industry plays a huge part in our health beliefs and behaviours. Adverts targeting young children with fast
food or sugary beverages negatively in
co-morbidities) and poor dental health, amongst other issues.
Environmental determinants
Living in an area at high risk of natural disaster, high air pollution, or extremes in climate a
diseases (e.g. asthma in areas of high air pollution), and forms barriers to accessing health care. Living in an area with a high
volume of fast-food outlets, and fewer opportunities to purchase healthy foods will have a subsequent impact on diet.
Cultural determinants
Di
hallucinations) are medicalised, or are embraced and considered to have a positive value.
3

Living and working conditions

Education
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Those who have higher levels of education tend to experience better health. This is through direct factors – they may be
better educated about health and wellbeing and thus know when to seek help from their doctor, and indirect factors – a
better education is likely to lead to a higher-paying job, which in turn is more likely to have sick pay, and support from
colleagues when unwell.
Health care services
The quality of your local health care service, how accessible it is, and how a
to access health care, and how well it will meet your needs and e
Work environment
Working a high-stress job, with low autonomy or control, is linked to higher stress levels and less satisfaction at work. This
has an impact on mental health, and stress-related physical health conditions, such as hypertension.
4
Housing
Those living in poor quality housing are more exposed to cold and damp, with associated mental health, or respiratory
conditions. Overcrowding raises the risk of infectious disease spread. Lack of housing (homelessness or rough sleeping)
can be both a cause and result of poor physical or mental health.
5

Social networks
Weak social networks are linked to conditions such as depression, hypertension and heart disease. Those with less support
are also more likely to participate in health-damaging activities, such as smoking and drinking alcohol. 6
Social networks
are sources of emotional and practical support.
7
Community cohesion
Communities which are grounded in trust, and can exercise control over their circumstances, have better self-rated health,
improved access and demand for health care and health food options, and lower rates of neighbourhood violence.
8

Individual lifestyle factors

Health behaviours
Factors such as smoking, drinking, hand washing, and diet all play a part in an individual’s risk of developing disease.
Control over health decisions
The decisions that an individual chooses to make are heavily in
opportunities they have had and play only a small factor in their health.
9

Age, sex and constitutional factors

Sex or gender
A person’s sex plays a part in their health risks\: women are more at risk of breast cancer, men are at risk of prostate cancer.
There are also social factors to consider – women are more likely to experience domestic violence, men are less likely to
report physical symptoms to their GP than women.
10,11
Age
Many medical conditions are more common at an older age, such as dementia, heart disease, diabetes and cancer.
Extremes of age a
Ethnicity
Black and minority ethnic groups in the UK have worse health outcomes than the general population. 12
There are
particular conditions which are more prevalent in these communities, for example, diabetes or hypercholesterolaemia.
13
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However, we know that the poorer socio-economic position of some ethnic groups, inequalities of service uptake, and
communication issues play a signi
14
Genetics
to live.
15
Genetics play a part in determining the likelihood of developing certain diseases, and how long and healthily we can expect

Conclusion

Although we can use frameworks such as this to consider all the various in
lesson is that these factors are all interlinked.
Considering the factors that determine our patients’ health not only allows us to build a stronger, more contextually
informed relationship with our patients, but also allows us to target health promotion interventions to address particular
lifestyle factors or ‘determinants’ of health and disease.

References

Dahlgren G, Whitehead M & World Health Organization. L e v e l l i n g u p (‎ p a r t 2 )‎ \: a d i s c u s s i o n p a p e r o n E u r o p e a n s t r a t e gi e s f o r
t a c k l i n g s o c i a l i n e q u i t i e s i n h e a l t h . 2006. Available from\: [LINK]
Figure 1. The Dahlgren and Whitehead model of social determinants of health. Licence\: [CC BY-NC].
Psychiatric times. A u d i t o r y h a l l u c i n a t i o n s i n p s y c h i a t r i c i l l n e s s . March 2010. Available from\: [LINK]
American psychological association. O c c u p a t i o n a l s t r e s s a n d e m p l o y e e c o n t r o l . November 2003. Available from\: [LINK]
Homeless link. H o m e l e s s n e s s a n d h e a l t h c a m p a i gn . Accessed Feb 2021.
Dahlgren G, Whitehead M. Po l i c i e s a n d s t r a t e g i e s t o p r o m o t e s o c i a l e q u i t y i n h e a l t h . B a c k g r o u n d d o c u m e n t t o W H O -
S t r a t e g y p a p e r f o r E u r o p e. Institute for Futures Studies. September 1991. Available from\: [LINK]
Healthy People.gov. S o c i a l c o h e s i o n . Available from\: [LINK]
Healthy People.gov. S o c i a l c o h e s i o n . Available from\: [LINK]
World Health Organisation. D e t e r m i n a n t s o f H e a l t h . Published in 2017. Available from\: [LINK]
Women’s aid. D o m e s t i c a b u s e i s a g e n d e r e d c r i m e . Accessed Feb 2021. Available from\: [LINK]
Men’s health forum. K e y d a t a \: u n d e r s t a n d i n g o f h e a l t h a n d a c c e s s t o s e r v i c e s . Accessed Feb 2021. Available from\: [LINK]
Patient Professional. E t h n i c i t y a n d h e a l t h . December 2015. Available from\: [LINK]
Diabetes UK. E t h n i c i t y a n d t y p e 2 d i a b e t e s . Accessed Feb 2021. Available from\: [LINK]
Patient Professional. E t h n i c i t y a n d h e a l t h . December 2015. Available from\: [LINK]
World Health Organisation. D e t e r m i n a n t s o f h e a l t h . February 2017. Available from\: [LINK]

Reviewer

Rebecca Pickup
ST5 Public Health

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Introduction
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General socio-economic, cultural and environmental conditions
Living and working conditions
Social and community networks
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The Social Determinants of Health