What are the Social Determinants of Health (SDH)?
“The social determinants of health (SDH) 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.” 1
SDHs cause health inequities that can be seen unfair and avoidable. The social gradient of health and illness represents the idea “the lower the socioeconomic position, the worse the health”. The social gradient of health can be observed in any country despite the levels of income. Education, working life conditions, food security, early childhood development and social protection are examples of SDHs, which may lead to influencing health in both positive and negative ways.2
Addressing SDHs is crucial when improving health and reducing inequities in health. In addressing SDHs all sectors of society are needed for action and recently there have been calls for “a systems approach” that enables understanding how SDHs work in combination and integrates action on different SDHs to reduce disease burden and inequalities. 3
Sources:
- World Health Organization (WHO), 2021. Social determinants of health. Available from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 [Read in Nov 2021]
- Marmot, M. & Wilkinson, R. 2005. Social Determinants of Health. Second edition. Oxford: Oxford University Press.
- Marmot, M. & Bell, R. 2019. Social determinants and non-communicable diseases: time for integrated action. https://doi.org/10.1136/bmj.l251
Commission on social determinants of health
The Commission on Social Determinants of Health (CSDH) was established by WHO in March 2005. The aim of the Commission was to support countries and global health partners in addressing the social determinants and factors that may lead to health inequities and ill health.
CDSH aimed to draw the attention of governments and society in general to the SDHs and thus, creating better social conditions for health, especially among the most vulnerable people. The Commission work led to Rio Conference on social determinants of health in 2011.
The essential recommendations of the Commission were to improve daily living conditions, tackle the inequitable distributions of resources, power and money and measure and understand the problem and assess the impact of action.
Source:
WHO 2021. Commission on Social Determinants of Health, 2005-2008. Available from https://www.who.int/teams/social-determinants-of-health/equity-and-health/commission-on-social-determinants-of-health [Read in Nov 2021]
The Commission report:
Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the commission on social determinants of health. Available from https://www.who.int/publications/i/item/9789241563703
More recent European reports:
European Commission 2013. Commission staff working document. Report on health inequalities in the European Union. Available from https://ec.europa.eu/health/sites/default/files/social_determinants/docs/report_healthinequalities_swd_2013_328_en.pdf
Marmot 2014. Review of social determinants and the health divide in the WHO European Region: final report. Available from https://www.euro.who.int/en/publications/abstracts/review-of-social-determinants-and-the-health-divide-in-the-who-european-region.-final-report