Social Determinants of Health

A basic principle of public health is that all individuals have a right to health and the conditions that allow for health. However, health is not equally or equitably distributed. In other words, there are both health inequalities and health inequities. Health inequalities, or health disparities, refer to differences in health status by group. For example, men and women have unequal rates of pregnancy and prostate cancer. These differences are related to gender and are based on biological differences not power differences.

priority populationsHealth inequities focus more specifically on those inequalities that are based on differential access to power and resources. Therefore, health inequities refer to systematic differences in health status among individuals who have access to different amounts of social resources – such as money, power, or prestige (Braveman & Gruskin, 2003). These differences may be related to the community you live in, your age, your racial or ethnic heritage, your gender, whether you have a disability, your sexual orientation and your socioeconomic status.

For example, people who live in higher income neighborhoods tend to enjoy better health and longer lives than people in lower income neighborhoods. This difference may reflect differential access to resources or exposure to negative environmental factors.

In trying to help individuals improve their health, health practitioners often provide medical services or recommend behavioral changes. These strategies have helped to create improvements in health status. However, in order to attain health equity, practitioners must also consider the social and environmental factors that affect health. This requires a comprehensive approach that targets change at multiple levels, including individuals, organizations and communities.

What are social determinants of health?
The social and environmental resources that affect health are often referred to as social determinants of health. There are significant differences in the distribution of these resources, and there is a significant association between these resources and health outcomes.

Social determinants are resources that are necessary to maintain health. Health inequities occur when those social determinants are distributed differentially across communities or groups. Communities have been defined or characterized in a number of ways including groups of individuals who live in a particular geographic area, who have some level of social interaction, who share a sense of belonging and/or a sense of shared political and social responsibilities. Each community has its own set of unique structures and norms that govern interaction. Any one individual may be part of many overlapping communities; each of which may have different access to social resources. Thus, individuals living in a community that is economically depressed may have less access to healthy food options and medical care than individuals living in another area regardless of the individual’s personal or family income.

Assessing social determinants of health inequities
With your partners around the table, you will want to identify and discuss the social determinants of health inequities in your community. This requires listening to the voices of the people and organizations in the community that benefit from or are limited by the experience of these inequities.

Once you have a “working definition” of community, you can begin to talk about the perceived health inequities and the reasons for these inequities. The following questions may help you to think about the social determinants of health inequities in your community:

  • Is this a healthy community? Why or why not?
  • Are some people healthier than other people in this community? Why or why not?
  • Does the history of this community influence the health of the community? How?
  • Do the values of the community influence the health of the community? How?
  • What are the assets of this community?
  • What are the obstacles in this community?
  • What is the relationship of this community to surrounding communities?
  • How do social or economic conditions influence health in the community?

After developing a list of these determinants, work with your partners to decide on the most important issues to address first. Consider the following in your discussion of priorities:

  • What determinants affect the largest number of people in your community?
  • Which determinants are relatively easier to change?
  • Are your partners willing to work to change the determinant?
  • What are the barriers to addressing this determinant?
  • Are there resources available to address this determinant?

Next, you and your partners can consider strategies that will enable you to create change in your community. Several strategies are available to choose from and you and your partners will have to decide what makes the most sense for your intervention and community. In addition to building community capacity, the following strategies may be useful:

  • consciousness raising to build common understanding;
  • community development;
  • social action;
  • individual health education;
  • community-wide media advocacy; and
  • structural change (policy and built environment) through public advocacy.

You should now consider the populations most affected by your priority health issues and select the priority population(s) for your intervention.


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