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Determinants of Health

Original Editor - Rachael Lowe

Top Contributors - Rachael Lowe, Wendy Walker, Naomi O'Reilly, Laura Ritchie, Kim Jackson, Jess Bell, Rucha Gadgil, Robin Tacchetti, Ewa Jaraczewska, Tarina van der Stockt, Vidya Acharya, Shaimaa Eldib and Carin Hunter  

Introduction

"Health care is an important determinant of health. Lifestyles are important determinants of health. But... it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place." WHO Director-General Dr Margaret Chan[1]

The health of individuals and communities is influenced by a wide range of factors. Where we live, our environment, genetics, income, education, and relationships can significantly impact our well-being. These factors often play a more crucial role in determining our health than access to and utilisation of healthcare services.[2]

People's health is determined by their life circumstances, so it is wrong to blame them for poor health or praise them for good health. Many health determinants are beyond individual control. These determinants, or factors that influence health outcomes, include but are not limited to:

Determinants of Health

The range of personal, social, economic and environmental factors that influence health status is known as determinants of health. These can be classified as:

  1. The social and economic environment
  2. The physical environment
  3. The person’s individual characteristics and behaviours


There are many commonly accepted determinants of health, but there is no single definition. The Office of Disease Prevention and Health Promotion (ODPHP) has broadly categorised the determinants of health[3] and these have been summarised below:

1. Policy-making

Individual and population health are influenced by policies at the local, state, and federal levels. For example, increasing taxes on tobacco sales can lead to improved population health by reducing tobacco use.[4] Unfavourable conditions can result due to substandard policies and programmes, inadequate governance and unfair economic arrangements.[5]

2. Social Factors

The conditions in which people are born, live, learn, play, work, and age are reflected in social and physical determinants of health. These determinants, also known as social determinants of health, affect a wide range of health outcomes, functioning, and quality of life.[4] They represent economic and political systems, physical and social environments, and health service access. Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life.[6]

Examples include:

  • Availability of resources to meet daily needs, such as educational and job opportunities, living wages or healthful foods
  • Social norms and attitudes such as discrimination
  • Exposure to crime, violence and social disorder
  • Social support and social interactions
  • Socioeconomic conditions such as concentrated poverty
  • Quality schools
  • Transportation options
  • Urbanisation and the built environment, such as buildings or transportation
  • Worksites, schools and recreational settings

** Poor health outcomes are associated with adverse conditions leading to social risk factors[7]

3. Health Services

Health is impacted by both access to and quality of healthcare services. Barriers to access include lack of availability, high cost, lack of insurance coverage, and limited language access. These can result in unmet health needs, delayed or lack of  preventive care, and preventable hospitalisations.[4]

4. Individual Behaviour

Individual behaviours such as diet, physical activity, alcohol, tobacco and other drug use also play a role in health outcomes.

5. Biology and Genetics

Some biological and genetic factors can influence specific populations' health more than others. Examples of biological and genetic determinants of health include age, sex, inherited conditions and genetic make-up.[4]

Improving Health Worldwide

WHO have identified three "common interventions" for improving health conditions worldwide:[8]

1. Education

Many studies have demonstrated a strong link between better education and better health,[9] and education is a reliable predictor of lower mortality rates.[10][11] The probability of being in good or very good health is higher for people with university or post-secondary education.[12]

2. Social Protection

Countries with some social protection (i.e. a safety net or social security system) show improved health and economic outcomes in circumstances where people cannot earn a living.[13]

3. Urban Development

The physical environment where communities live has a great impact on the health of the residents.[14][15] Factors which have a negative impact on health include overcrowding, damp living conditions and crime (in particular fear of crime). The WHO concludes that health outcomes "are largely determined by the accessibility to adequate housing and healthy and safe urban environments and by transport conditions".[8]

Relevance to Rehabilitation

In our contact time with our patients, we spend a lot of time understanding their health and social status. In other words, we explore the determinants that might be affecting their health and in particular ones that we can influence. The model we use to analyse and understand these determinants of health is the biopsychosocial model of health care.

It is essential that healthcare workers dedicated to improving health increase their effectiveness by addressing the “upstream” causes of health in the community and by engaging in ways to change the broad policies, systems and environments that shape the social and economic conditions that, in turn, so strongly influence health. Swain et al.[16] describe opportunities for the health-care professional to address social determinants of health. They suggest that to be most effective at improving the health of families and communities and to ensure the greatest impact for the investment of resources, health professionals need to expand their repertoire of skills and activities both with their individual patients and in the policy arena.

Resources

References

  1. ↑ Dr Margaret Chan. Launch of the final report of the Commission on Social Determinants of Health. 2008. Accessed online 6 January 2017.
  2. ↑ Determinants of health. World Health Organization. Geneva 2024. Available from https://www.who.int/news-room/questions-and-answers/item/determinants-of-health [accessed 26.03.2025]
  3. ↑ Office of disease prevention and health promotion. Determinants of Health. Accessed online 6 January 2017.
  4. ↑ 4.0 4.1 4.2 4.3 Determinants of Health, Risk Factors, and Prevention. Available from https://courses.lumenlearning.com/atd-herkimer-health/chapter/determinants-of-health-risk-factors-and-prevention/ [accessed 26.03.2025]
  5. ↑ Islam MM. Social determinants of health and related inequalities: confusion and implications. Frontiers in public health. 2019 Feb 8;7:11.
  6. ↑ Palmer RC, Ismond D, Rodriquez EJ, Kaufman JS. Social Determinants of Health: Future Directions for Health Disparities Research. Am J Public Health. 2019;109(S1):S70-S71.
  7. ↑ Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. The Milbank Quarterly. 2019 Jun;97(2):407.
  8. ↑ 8.0 8.1 World Health Organization (2013). The economics of social determinants of health and health inequalities: a resource book (PDF). World Health Organization. ISBN 978-92-4-154862-5
  9. ↑ Knesebeck O et al. Education and health in 22 European countries. Social Science and Medicine, 2006, 63:1344–1351
  10. ↑ Muller A. Education, income inequality, and mortality: a multiple regression analysis. BMJ, 2002, 324(7328):23–25
  11. ↑ Deaton A, Paxson C, eds. Mortality, education, income, and inequality among American cohorts. Chicago, University of Chicago Press, 2001
  12. ↑ Hurd M, Kapteyn A. Health, wealth, and the role of institutions. Journal of Human Resources, 2003, 38(2):386–415
  13. ↑ Chung H, Muntaner C. Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy, 2007, 80(2):328–339
  14. ↑ Chung H, Muntaner C. Welfare state matters: a typological multilevel analysis of wealthy countries. Health Policy, 2007, 80(2):328–339
  15. ↑ Thompson S et al. Do urban regeneration programmes improve public health and reduce health inequalities? A synthesis of the evidence from UK policy and practice (1980–2004). Journal of Epidemiology and Community Health, 2006, 60(2):108–115
  16. ↑ Swain et al. Health Care Professionals: Opportunities to Address Social Determinants of Health. 2014. WMJ, 113:6
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