The social determinants of health (SDOH) refers to the economic and social conditions that influence individual and group differences in health status.
There are health promoting factors found in one’s living and working conditions: income, wealth, influence, and power, that influence the risk for a disease, or vulnerability to disease or injury.
Similarly, individual risk factors, such as behavioral risk factors or genetics influence the risk for a disease, or vulnerability to disease or injury.
Social determinants of health are often shaped by public policies that reflect prevailing political ideologies of the area.
The World Health Organization holds that health-damaging experiences is the result of a toxic combination of poor social policies, unfair economic arrangements, where the already well-off and healthy become richer and the poor who are already more likely to be ill become even poorer], and bad politics.
Social determinants of health include: the social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food, and transportation.
Social determinants of health, such as food supply, housing, insurance coverage, economic and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life.
Health equity among the population is not possible without equitable distribution of social determinants among groups.
Health inequality between men and women harms many societies.
Women have historically experienced a disproportionate amount of health inequity.
Differences in health status, health outcomes, life expectancy, and many other indicators of health occurs in different racial and ethnic groups.
Racial groups are unequally affected by diseases, in terms or morbidity and mortality.
Individuals in certain racial groups receive less care, have less access to resources, and live shorter lives in general.
Racial health disparities appear to be rooted in social disadvantages associated with race such as implicit stereotyping and average differences in socioeconomic status.
Health disparities suggest that preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.
Centers for Disease Control and Prevention, indicate that health disparities are intrinsically related unequal distribution of social, political, economic and environmental resources.
Social conditions affect health is illustrated by the association between education and mortality rates: studies show mortality rate for adults aged 25 to 64 years with little education beyond high school, is twice as great for those with only a high school education and 3 times as great for those less educated.
In wealthy countries, income and mortality are correlated as a marker of relative position within society, and this relative position is related to social conditions that are important for health including good early childhood development, access to high quality education, rewarding work with some degree of autonomy, decent housing, and a clean and safe living environment.
People who lack social participation and control over their lives are at a greater risk for heart disease and mental illness.[32]
Early childhood development can be promoted or disrupted as a result of the social and environmental factors effecting the mothe.
People living in poverty experience a number of negative health determinants.
International health inequalities[edit]
The impact of globalization has resulted in an uneven distribution of wealth and power both within and across national borders, and where and in what situation a person is born has an enormous impact on their health outcomes.
There are marked differences among developed nations in health status indicators such as life expectancy, infant mortality, incidence of disease, and death from injuries.
Migrants and their family members experience significant negative health impacts.
Access to health care is essential for equitable health, and it can be argued that health care should be a common good.
There are 2 primary mechanisms for understanding how social determinants influence health: cultural/behavioral and materialist/structuralist.
Behavioral choices are determined by one’s material situation, and these behavioral risk factors account for a relatively small proportion of variation in the incidence and death from various diseases: access to the amenities of life, working conditions, and quality of available food and housing.
A nation’s wealth is a strong indicator of the health of its population, and within nations, however, individual socio-economic position is a powerful predictor of health.
Material conditions of life influence health by the quality of individual development, family life and interaction, and community environments:
Likelihood of infections, malnutrition, chronic disease, and injuries, developmental delay or impaired cognitive, personality, and social development, learning disabilities, early school leaving, poor learning, and socialization, preparation for work, and family life problems.
Unsatisfactory material conditions of life also lead to psychosocial stress.
Chronic stress of a fight-or-flight reaction to constant threats to income, housing, and food availability, weakens the immune system, increases insulin resistance, lipid and clotting disorders appear more frequently, and increases the adoption of health threatening behaviors.
Chronic stress has been found to be significantly associated with chronic low-grade inflammation, slower wound healing, increased susceptibility to infections, and poorer responses to vaccines.
The environment influences whether individuals take up tobacco, use alcohol, consume poor diets, and have low levels of physical activity.
These behaviors are also used to cope with difficult circumstances, explaining the influence of social determinants, and ability to cope with difficult circumstances.
Nations, regions, and cities differ on how economic and other resources are distributed among the population, thereby affecting the social determinants of health.
One’s perception and experience of one’s status in unequal societies lead to stress and poor health.
Feelings of shame, worthlessness, and envy can lead to harmful effects upon neuro-endocrine, autonomic and metabolic, and immune systems.
When comparing to those of a higher social class behavioral attempts to alleviate such feelings can occur with overspending, taking on additional employment and adopting health-threatening coping behaviors such as overeating and using alcohol and tobacco.
The widening of social hierarchy weakens social cohesion, which is a determinant of health.
The economic and social conditions, which are the social determinants of health – under which individuals live their lives have a cumulative effect upon the probability of developing any number of diseases, including heart disease and stroke.
Adverse economic and social conditions across a life span predispose individuals to diabetes.
Low birth weight is a reliable predictor of incidence of cardiovascular disease and adult-onset diabetes in later life.
Nutritional deprivation during childhood has lasting health effects.
Children who enter school with delayed vocabulary have lower educational expectations, poor employment prospects, and greater likelihood of illness and disease across the lifespan.
Poor-quality neighbourhoods, schools, and housing are not conducive to health and well-being.
The effects of cumulated disadvantaged social determinants of health manifests itself in poor health.
Social determinants of health operate at every level of development: in utero, infancy, early childhood, childhood, adolescence, and adulthood.
There is a relationship between elevated stress levels and slower healing for many different acute and chronic conditions.
Coping styles and social support, can mitigate the relationship between chronic stress and health outcomes.
Chronic stress is common low socio-economic individuals who have worries about financial security, and may lack the emotional resources to adopt positive health behaviors, or prioritize their health.
The response to chronic stress may lead to positive or negative coping behaviors.
Coping with stress through positive behaviors such as exercise or social connections diminishes the adverse effects between stress and health, whereas those with a coping style more prone to over-consumption by emotional eating, drinking, smoking or drug use are more likely to be see negative health effects of stress.
Countries that have high levels of income inequality have poorer health outcomes compared to more equal countries.
The stressors associated with low social status are amplified in societies where others are clearly far better off.
Exposure to long working hours, operating through psychosocial stress, is the occupational risk factor with the largest attributable burden of disease.
The three common interventions for improving social determinant outcomes as identified by the WHO are education, social security and urban development.
Such interventions strongly affect children’s health outcomes.
Increased quantity and quality of education leads to benefits to both the individual and society: improvements can be seen in health measures such as blood pressure, crime, and market participation trends.
The urban development interventions include housing, transportation, and infrastructure improvements such as smoke alarm installation, concrete flooring, removal of lead paint, can have a direct impact on health.
Transportation improvements or improved walkability of neighborhoods can have health benefits.
Affordable housing options contribute to both social determinants of health, and access to public natural areas -including green and blue spaces- is also associated with improved health benefits.
Elevated stress hormones in children interfere with the development of brain circuitry and connections, causing long term chemical damage.
In most wealthy countries, the relative child poverty rate is 10 percent or less; in the United States, it is 21.9 percent.
The lowest poverty rates are more common in smaller well-developed and high-spending welfare states like Sweden and Finland, with about 5 or 6 percent.
Middle-level rates are found in major European countries where unemployment compensation is more generous and social policies provide more generous support to single mothers and working women and where social assistance minimums are high, Netherlands, Austria, Belgium and Germany have poverty rates that are in the 7 to 8 percent range.
Social determinants of health are usually a result of public policy decisions made by governing authorities.
Early life is shaped by availability of sufficient material resources that assure adequate educational opportunities, food and housing among others.
Unconditional cash transfers may not improve health services use, but they lead to a large, clinically meaningful reduction in the likelihood of being sick by an estimated 27%.
Unconditional cash transfers may also improve food security dietary diversity, and children in recipient families are more likely to attend school, and may increase money spent on health care.
Sexual orientation and gender identity are increasingly recognized as social determinants of health.
The key factors that influence whether people are healthy or unhealthy include the following:
Education and literacy Employment/working conditions Income and social status Physical environments Social environments Social support networks Biology and genetics Culture Gender Health care services Healthy child development Personal health practices and coping skills
Pegnancy complications, including preterm delivery and low birthweight outcomes for newborn infants and morbidity and mortality for mothers, demonstrate considerable racial/ethnic, rural/urban, and socioeconomic disparities.