THE SOCIAL DETERMINANTS OF

HEALTH

COMMUNITY MEDICINE
 LEARNING OBJECTIVES

Identify the socioeconomic, biological and behavioral

1 factors that influence health

Explain the social determinants of health

2
 KWENTO NI ROSARIO

What caused her condition?

What are the determinants of health that led to her situation?
 SDOH NI ROSARIO

 Health care
 Ill-equipped health center, expensive private hospitals
 Health behaviors
 Uninformed, poor health practices
 Physical environment
 Congested living area, poor sanitation, lack of water
 Socio-economic factors
 Unemployed parents, education, social class
 DEFINITION OF HEALTH

Health is a state of complete physical, mental and social well-being, and not merely the absence of
disease or infirmity.
- (World Health Organization, 1948)

Health is an individual right and a social justice issue. It is also a public good.

Governments have a responsibility for the health of their peoples which can be fulfilled only by the
provision of adequate health and social measures.
Quiz
1. According to WHO, what is the definition of health?
 FACTORS DETERMINING HEALTH

Clinical care is less important than many people think

whereas socioeconomic factors and the physical environment
are quite influential on health and well-being.

Genetic characteristics are also less significant

than many people think.

Whether people are healthy or not, is determined by their circumstances and environment –
the social, economic and environmental conditions which affect the health of the population.
 WHY FRAME HEALTH IN TERMS OF
SOCIETAL CONDITIONS?

IMPACT: 30 - 50% OR MORE

Canadian Institute of
Mc Giniss
Advanced Research
et al (2002)
(2012)

Health care
Health care
(up to 15%)
(up to 25%)
Social circumstances
Socioeconomic (50%)
& environmental exposure
(45%)
Environmental (10%)
Health behaviour patterns
Genetics (15%)
(40%)

Figure: Estimates of the contribution of the main drivers of health status.

Source: Donkin, A., P. Goldblatt, J. Allen, V. Nathanson and M. Marmot (2017).

"Global action on the social determinants of health." BMJ Global Health.
 WHAT ARE THE SOCIAL DETERMINANTS
OF HEALTH?

The social determinants of health are the conditions in which people are born,
grow, live, work and age. These circumstances are shaped by the distribution of
money, power and resources at global, national and local levels.

The social determinants of health are mostly responsible for health inequities – the unfair
and avoidable differences in health status seen within and between countries.

The social determinants of health are multi-layered

and range from societal to individual factors.
Quiz
2. How many percent is related to individual clinical patient
care?
3. How many percent is tied up to the health of a person
related to public health?
 THE SOCIAL DETERMINANTS
OF HEALTH

SOURCE: DAHLGREN G AND WHITEHEAD M (1991)

P O L I C I E S A N D S T R AT 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 LT H . S T O C K H O L M , I N S T I T U T E O F F U T U R E S T U D I E S .
SOCIAL DETERMINANTS OF HEALTH
We Need To Consider Each Factor To Address The Social Determinants Of Health
 SOCIAL DETERMINANTS OF HEALTH
CONCEPTUAL FRAMEWORKS

Global
PAHO Equity Dahlgren
Commission
Commission & Whitehead
on SDH
(2019) (1991)
(2008)
GLOBAL COMMISSION ON SOCIAL DETERMINANTS OF
HEALTH CONCEPTUAL FRAMEWORK (2008)

SOCIOECONOMIC
POLITICAL

CONTEXT
SOCIOECONOMIC
Material Circumstances
Governance POSITION (Living and Working,
Conditions, Food
Macroeconomic Availability, etc.) IMPACT ON
Policies SOCIAL CLASS EQUITY IN
GENDER Behaviours and Biological HEALTH AND
Social Policies ETHNICITY (RACISM) Factors WELL-BEING
Labour market,
Housing, Land Psychosocial Factors

Public Policies, EDUCATION

Education, Health, Social cohesion & Social capital
Social protection
OCCUPATION
Culture and
Societal value
INCOME HEALTH
SYSTEM

STRUCTURAL DETERMINANTS INTERMEDIARY DETERMINANTS OF

OF HEALTH INEQUITIES HEALTH
Quiz
4-5. What are the 2 categories of the social determinants of health?
WHY ADDRESS SOCIAL DETERMINANTS OF
COMMUNITY HEALTH AND DEVELOPMENT?
If you want to solve or prevent a problem for the long term, you have to deal with its root
causes.
If you address the root causes, you’re more likely to successfully address the issue for the short
term as well.
The social factors involved may have more resonance for those affected than the issue itself.
It may be easier to approach an issue through its underlying social factors than to deal with it
directly. 
Addressing the social determinants of community issues is crucial to understanding them fully,
so that your strategy and tactics for dealing with them correspond to reality.
Addressing social determinants presents a tremendous opportunity for learning and community
leadership development. 

Reference: ctb.ku.edu
WHO SHOULD ADDRESS SOCIAL DETERMINANTS
OF COMMUNITY HEALTH AND DEVELOPMENT?
Those affected by the issues (the targets of change).
Those who can have an effect on the issues (the agents of change).
Staff members from organizations that work directly with the target population
and/or the issue.
Respected community leaders and citizens.
Those who will be asked to change, sacrifice, or take action in order to address
the issue.
Anyone else who has a stake in the issue.

Reference: ctb.ku.edu
WHEN SHOULD YOU ADDRESS SOCIAL
DETERMINANTS OF COMMUNITY HEALTH AND
DEVELOPMENT?
When it’s clear that simply focusing on the issue isn’t enough.
When you’re advocating for changes in laws, policies, or funding.
When you’re seeking fundamental change.
When you’re seeking a long-term solution to a long-term problem.
When your focus is on community wellness and prevention.

Reference: ctb.ku.edu
HOW CAN WE CHANGE THESE
DETERMINANTS OF HEALTH?

Global Commission on SDH

(2008) –

3 overarching
recommendations
 PRIORITY RECOMMENDATIONS:
THE GLOBAL COMMISSION
The World Health Organization’s Commission on Social Determinants
of Health final report (2008) contains three overarching recommendations -

Improve daily living conditions:

1
the circumstances in which people are born, grow, live, work, and age

Tackle the inequitable distribution of power, money and resources:

2
the structural drivers of those conditions of daily life – globally, nationally, and locally

3 Measure and understand the problem and assess the impact of action: expand the
knowledge base, develop a workforce that is trained in the social determinants of health,
and raise public awareness about the social determinants of health
 TASK

Read the Rio Political Declaration on Social

Determinants of Health:
- 6-10. What are the 5 themes of the Declaration to address health
inequities?