SOCIAL DETERMINANTS OF

HEALTH
The social determinants of health are the economic
and social conditions and their distribution among
the population that influence individual and group
differences in health status.
They are health promoting factors found in one's
living and working conditions (such as the
distribution of income, wealth, influence, and
power), rather than individual risk factors (such as
behavioral risk factors or genetics) that influence
the risk for a disease, or vulnerability to disease or
injury

PROVISION OF HEALTH CARE

Focus on Life-styles
Focus on the
Environment
Shift focus from
individuals to populations
PRODUCING
HEALTH

Cost-effective health care

Evidence-based decision/
policy
Resources to sector that
contribute to
health
3

Health System
a set of cultural beliefs and practices;

the institutional arrangements; and

the socio-economic, political & physical context
Health system includes environmental
conditions, nutrition, water supply, education,
housing, status of women, social structures,
economic and political system
4

Factors influencing health

service utilization

Socio-demographic factors
Age/sex of child
Family size/ parity
Education
Occupation
5

Economic factors
Possession of household items
Possession of cattle
Possession of agriculture land
Type of residential house

Physical accessibility factor

Availability of the transport
Physical distance for Health
Facility/Health Care Provider
Time taken to reach Health
Facility/Health Care Provider
7

Health service factors

Attitudes of health provider

Satisfaction with the treatment
Received medicines from Health
Facility/Health Care Provider
Received prescription for medicines
to be purchased from bazaar
8

Mothers autonomy

Freedom to visit HF alone

Permission to spend money on
health
Decision power in emergency
situation
9

Challenges
Knowledge of illness/wellness and of
services available
Perceptions of services/service
providers
Risk/symptoms assessment
Cultural prescriptions
Social barriers/social pathways to care
Etc
10

Income influences health

People in the top income bracket are
healthier than middle income earners

Middle income earners are, in turn,

healthier than people with low income
This means that the poorer people are,
the less healthy they are likely to be.
11

Social status affects health

It affects health by determining the

degree of control people have over life

circumstances
It affects their capacity to act and
make choices for themselves
Higher social position and income
somehow act as a shield against disease.
12

Gender influences health

Gender is linked more to the roles, power

and influence society gives to men and
women, than it is to their biological
differences.

Women tend to schedule more

doctor visits than men, but why?
13

Culture influences health

Culture and ethnicity influence how people link
with health system, their access to health
information and their lifestyle choices.
Dominant cultural values largely determine the
social and economic environment of communities.
Result:
Marginalization
Loss/devaluation of culture and
language
Lack of access to culturally appropriate
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Health Care
system 25%

Biological
endowment 15%

Physical
environment 10%

Socio-economic
environment 50%

Estimated Health Impact of Determinants of Health on

15
Population health Status: CIAR 1997

Importance of Social & Cultural Factors in Healthcare

A.The ways people think about health and illness
B.Individual behaviors and habits that influence health
C.How you and your actions are perceived by the community where
you work
D.How culture interacts with environment, economy, and politics to
affect health

Culture
A system of thoughts & behaviors
shared by a group of people
Our cultural backgrounds have
tremendous impact on our lives
Culture contributes to the richness
of human experience
2003 Tom Furtwangler, Courtesy of
Photoshare

Culture Includes More Than Just Ethnicity

Reflection: Your assumptions about

childbirth
At what age is it appropriate for a
woman to get pregnant? Under what
circumstances?
How many children should a family
have?
To whom do children belong?
Who should be involved in the
pregnancy? Childrearing?
What is the role of Medicine in
reproductive health?
Where should women have their
babies?
Who should deliver babies?

How Social & Cultural Factors Relate to Health & Illness

Social scientists designate a difference between disease and illness:
Illness is the personal, social, & cultural influences on the experience
of impairment, pathology, & disease
Disease is the physiological process of pathology
The framework that focuses on illness is called the Sociocultural Model

African Americans have higher rates of mortality than does any other
racial or ethnic group for 8 of the top 10 causes of death
The cancer incidence rate among African Americans is 10% higher than
among European Americans.
U.S. Latinos have higher rates of death from diabetes, liver disease, and
infectious diseases than do non-Latinos.
Adult African Americans and Latinos have approximately twice the risk as
European Americans of developing diabetes.
Asian Americans are 60% more likely to being at risk of developing
diabetes in comparison to European Americans and are more likely to
develop the disease as lower BMIs and lower body weights.
South Asians are especially more likely to developing diabetes as it is
estimated South Asians a 4x's more likely to developing the disease in
comparison to European Americans
WHAT DOES THIS MEAN IN ASIAN PEOPLE.
Recent immigrants to the United States from Mexico have better
indicators on some measures of health than do Mexican Americans who
are more assimilated into American culture. Diabetes and obesity are

Case Example: Social and Cultural

Determinants of Health

In Nepal, life expectancy of men eclipses that of women.

Leading causes of death for women are pre/post labor
complications, hemorrhage, and infection.
Cultural factors such as early marriage contribute to the
problem, particularly in rural areas.
Social factors such as education and literacy also influence
health outcomes.
Social Factors

Social Factors
Health : Culture
Biology

Behavioral Medicine Behavioral and psychosocial factors significantly

influence health and disease
A branch of psychosomatic medicine
Uses methods of psychological intervention and behavior modification to
prevent and relieve illness
Treatment targets patterns of behavior & thought
Key strategies:
Lifestyle changes: nutrition, exercise, stop smoking
Counseling: Psychotherapy, pain management
Social support: Group education, caretaker support

Now that youre aware of

sociocultural factors for your
patients and yourself what do
you do with this knowledge?