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The social determinants of health (SDH) 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.
Social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care.
Addressing social determinants of health is important for improving health and reducing longstanding disparities in health and health care.
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.
The SDH have an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.
The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways:
- Income and social protection
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities and the environment
- Early childhood development
- Social inclusion and non-discrimination
- Structural conflict
- Access to affordable health services of decent quality.
Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.
Addressing SDH appropriately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil society.
This report has been produced by the Institute of Health Equity and commissioned by the Health Foundation to mark 10 years on from the landmark study Fair Society, Healthy Lives (The Marmot Review).
The report highlights that:
people can expect to spend more of their lives in poor health
improvements to life expectancy have stalled, and declined for the poorest 10% of women
the health gap has grown between wealthy and deprived areas
place matters – living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly five years less.
UCL Institute of Health Equity (2021)
Commissioned by the Greater Manchester Health and Social Care Partnership this review, ‘Build Back Fairer in Greater Manchester: Health Equity and Dignified Lives’, includes bold and ambitious recommendations on how to reduce health inequities and build back fairer from the COVID-19 pandemic for future generations. A new Framework is part of the review and comes as life expectancy falls for everyone across the UK, and health inequities widen, at a cost of £39 billion every year.
The Health Foundation (2018)
This guide explores how a person’s opportunity for health is influenced by factors outside the health and social care system.
It also shows that many people don’t have the same opportunities to be as healthy as others.
It contains suggestions for further reading and, with the help of short case studies, highlights how action can create improvements in the health of the whole population, for the lasting benefit of individuals, society and the economy.
The guide has been written for anyone with an interest in people’s health and wellbeing, and will be especially useful to those new to the social determinants of health.
Public Health England (2018)
This edition focuses on some of the actions that local areas can take to reduce health inequalities experienced by people living with mental illness, so that they achieve the same health outcomes and life expectancy as the rest of the population.Public Health, England (2018)
Ruth S. Shim, American Psychiatric Publishing (2015)
The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care.
World Health Organization (2014)
Mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical enviro nments in which people live.
• Social inequalities are associated with increased risk of many common mental disorders.
• Taking action to improve the conditions of daily life from before birth, during early childhood, at school age, during family building and working ages, and at older ages provides opportuni- ties both to improve population mental health and to reduce the risk of those mental disorders
that are associated with social inequalities.
• While comprehensive action across the life course is needed, scientific consensus is consid-
erable that giving every child the best possible start will generate the greatest societal and
mental health benefits.
• Action needs to be universal: across the whole of society, and proportionate to need in order
to level the social gradient in health outcomes.
• This paper highlights effective actions to reduce risk of mental disorders throughout the life
course, at the community level and at the country level. It includes environmental, structural, and local interventions. Such actions to prevent mental disorders are likely to promote mental health in the population.
(Source: WHO, 2014)
Impacts of Structural Racism, Socioeconomic Deprivation, and Stigmatization on Mental Health Ned H. Kalin, M.D., American Journal of Psychiatry (2021) As a field, we need to prioritize critical social and environ- mental factors that impact individuals’ well-being and men- tal health. The degree of trauma and stress associated with structural racism, socioeconomic deprivation, and the stig- matization of mental illness is immense, and because of its pervasiveness its toll on human suffering is inestimable.
Peter Kinderman et al, Minimal use of ICD social determinant or phenomenological codes in mental health care records, Journal of Mental Health (2021): Social determinants recorded in only 0.2% of mental health contact cases
Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity Ruth S. Shim, M.D., M.P.H. American Journal of Psychiatry (2021)
Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity Samantha Artiga and Elizabeth Hinton, Kaiser Family Foundation, USA (2018)
The Social Determinants of Mental Health, Lloyd I. Sederer, M.D.
(2015) Ninety percent of the determinants of our health derive from our lifetime social and physical environment—not from the provision of health care. Better health and mental health can be achieved by understanding and responding to these determinants of health. Psychiatry Online (2015)
The Social Determinants of Health: It's Time to Consider the Causes of the Causes Paula Braveman, MD, MPH and Laura Gottlieb, MD, MPH (2014)
Reducing inequalities in mental illness, Public Health England, (2018)
Professor John Newton outlines what commissioners and local authorities can do to reduce health inequalities experienced by those living with or recovering from mental illness, so that they achieve the same health outcomes and life expectancy as the rest of the population. Health Matters collection page: http://bit.ly/Healthmatters.