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Social Determinants of Health


The economic and social factors that affect the health of citizens in the community are referred to as the social determinants of health. The health of individuals and communities is not only measured by the dietary needs, physical and behavioral risks of the individual as appears to be the focus of most biomedical diagnosis. It encompasses a lot more than these factors. The social determinants of health are resources necessary to the community or individual in order for them to lead a normal and healthy life. The quantity and quality of these resources is significant as it influences the general health of a community. Some of the factors that affect health are the childhood health conditions of individuals. This factor determines the health of an individual since it is a foundation to his or her life.

Negative conditions during childhood are likely to lead to negative health in adulthood. Income is another condition that influences the health of an individual. When there is a regular and sufficient income, an individual is able to access a nutritious diet thus eliminating risks of getting ill. Lack of a steady income translates into an unhealthy feeding habit, and thus vulnerability to illnesses. This is just an overview of how social conditions determine the health of an individual or a community.

Social Determinants of Health

As indicated earlier, social determinants of health are factors that are social in nature but which have a negative or positive impact on the health of the individual. Most of these factors are interrelated, as subsequent discourse will reveal. The following are some of these factors:

Income Availability

Government agencies that continually carry out research have regularly graded the improvement of different economies around the world. However, these findings rarely reflect the actual situation on the ground. People with high income in the society have overshadowed the fate of low income earners (Raphael, 2004). This means that the gap between the rich and poor in the society is widening, a condition that is promoting ill health in the community. The level of income determines accessibility to certain services such as medical aid, social assistance pension and other benefits by the individual. The failure of low income earners to access these benefits and services leads to unhealthy living since they can not benefit from the health care facilities. The services are too expensive for them to afford. Income distribution is affected by economic recessions, among other factors, and it affects everyone in the society (Raphael, 2004).

The only problem is that when the economy recovers, the benefits accrued are not equally distributed between the poor and the rich. This means that the high income earners quickly get back to their normal earning levels while low income earners fail to recover. The latter’s lack of resilience strains their earning power even more. The poor can not afford to pay for quality healthcare services since their income level limits them (Raphael, 2004). They are also not beneficiaries of the government schemes that help citizens. For example, they can not access good homes, which is a necessity for good health. The individuals who are financially unstable experience high rates of morbidity and premature death. The gap between the ‘rich’ and ‘poor’ in the society may also be linked to increased mortality rate (Raphael, Bryant, & Marcia, 2006).

Communities with low socioeconomic status are vulnerable to diseases than those of high socio-economic status. This means the former have reduced ability to respond to any disease attack or to prevent disease outbreaks. This is in regard to environmental and economic capacity to undertake preventive measures that will guard them against infections. Since the individuals from low income families are not able to cater for the expensive health services that are of high quality, they are left to survive by the mercies of the elements (Raphael,2004).

The income levels and economic status also determines people’s personal behaviors. The personal behaviors also determine the health of individuals. Although America spends about two trillion dollars on health per year, still many Americans die young and lead sick lives (California News Reel, 2007). From this we learn that inequality in income makes communities sick. If people with low income can be educated on their life styles they can lead long and healthy lives. Approximately 47 million people can not access health insurance. These calls for the government to come up with public policies that can help avail insurance to more people in order for them to access health care services (California News Reel, 2007).

The Education Levels

Education is a basic necessity to every child. It is important because it increases opportunities for an individual to succeed socially and be able to access economic and social benefits in the society.The education levels of individuals affect their health directly (Doshi, 2010). The relationship between education and levels of income is that individuals with high income are able to access quality education. This is as opposed to the low income earners who can not access education (Personal Communication, 2010).

The economic and social benefits in the society are equally distributed through the provision of quality education to all. The education will equip members of the society with necessary knowledge on their health and especially how to stay healthy. The quality of education has both a direct and an indirect link with the health status of the people or a community. Therefore, it can be assumed that education is a social determinant of health since it has an impact on the health of individuals and communities (Doshi, 2010).

When the education levels are low and the community is largely illiterate, for example due o poverty, individuals are highly vulnerable to negative health conditions. Children who are faced with problems such as disabilities are less likely to complete their education. Students with special needs such as the dumb, deaf and lame require special attention in order to be able to access education (Raphael, 2004). If the community lacks facilities to cater for physically disabled children, then it can be said that education is a social determinant of health in this community. It hinders the students from accessing education which will enable them learn how to cope with their situation and in the long run, do something useful with their lives (Doshi, 2010).

Quality health education can also help reduce the vulnerability of different individuals to ill health. Having knowledge on the causes of various health problems is a preventive measure towards the same. Research has it that quality education provides individuals with strong foundations and ability to make choices regarding their occupation in the future (Personal Communication, May 12, 2010). A well paying career gives one greater influence and control over their levels of income, choice of home location, and also over the various factors which influence their health (Peterborough County-City Health Unit, 2009).

Healthy Living Conditions

The living conditions of individuals or a community have a great impact on their health and wellbeing. The cost of housing does not favour the low income earners as compared to those with high levels of income. A discerning look at the cost of renting suitable housing reveals that the economically disadvantaged or the low income earners can not access them. Statistics from different areas in Canada reveals the gravity of the housing crisis within the country (South Australian Council of Social Services, 2008). Statistics from a housing survey carried out by this organisation revealed that majority of respondents who had an income ranging between $250 and $349 paid a median rent of $180 to $224 in a week (South Australian Council of Social Services, 2008).

The cost of renting houses privately has steadily increased in relation to other costs of basic commodities such as fuel, utilities and food. People with low incomes, including government scheme beneficiaries, find it extremely difficult to exist and cope financially within the society (South Australian Council of Social Services, 2008).

The contribution of healthy living to the individual’s health status is not complete without mentioning the importance of nutrition. Access to nutritious food and potable water is very important to people’s health and wellbeing. Special emphasis is given to those in their early life. Access to nutritious food is determined by the levels of food literacy and also by geographical location. Levels of food literacy provide the connection between levels of education and conditions of living as social determinants of health. Many disadvantaged communities or low income earners can not access retail outlets that sell fresh and nutritious food. This is for example those individuals living in city slums (Peterborough County-City Health Unit, 2009).

Processed food joints commonly known as fast food outlets outnumber the grocery stores dealing with fresh food in areas occupied by low income earners. This trend causes a shortage of healthy and nutritious foods to these individuals. A shortage of these healthy foods is the common factor leading to the occurrence of deficiency diseases and increased morbidity within such communities. Due to poor living conditions, access to clean drinking water is curtailed. This is common within rural and remote areas in the country. Another problem that poses a health hazard apart from lack of safe drinking water is access to electricity and sewerage services (South Australian Council of Social Services, 2008).

This scenario depicts the deplorable living conditions that are likely to cause illness and health problems to the community. Members of the community must have necessary resources availed to them to avoid illnesses and an unhealthy existence. Healthy living condition is a social determinant of health given that when the conditions are conducive, a community will lead a healthy life. But once the scales tip to the negative side, then we expect a community that is not healthy (Raphael et al, 2006).

Access to Health Care

As earlier indicated, the ability to access quality and appropriate health care services is vital to the community for a healthy existence. It has effects over the individuals’ health and wellbeing, with emphasis on those who are from low income earning group. These are individuals that are likely to have had health problems since birth. There is need to ensure that these people are able to access the appropriate primary health care facilities (South Australian Council of Social Services, 2008). These services will play a vital role in preventing occurrence of disease and illnesses. These are for example preventive health care services such as immunisation of children and other services targeted at promoting public health. The government has a responsibility of ensuring that they identify and eliminate barriers to access of health services by the community members or individuals (Peterborough County-City Health Unit, 2009).

Levels of income determine the individual’s access to education. Levels of education, on the other hand, determine the ability of the individual to access quality health care services (Personal Communication, May 12, 2010). For example, an illiterate individual is less likely to be aware of the importance of preventive services such as immunisation. As such, their ignorance will curtail their access to quality health services.

According to a health survey carried out in Australia in 2006 by the Australian Institute of Health and Welfare, it was revealed that mortality and morbidity figures were high within communities living in low income areas (Peterborough County-City Health Unit, 2009).

The survey revealed that between the years 2000 and 2002, death rates recorded for infants from low income areas in Australia was double the death rates of those from the more advantaged areas or high income areas (South Australian Council of Social Services, 2008). Another comparison depicted that 75% of boys and 46% of girls from low income areas had higher mortality rates than their colleagues from the affluent areas. The survey also found that the mortality rate of males living in lower socioeconomic areas between the years 1998 and 2000 was 80% higher than for males living in affluent areas (Southern Public Health Unit Network, n.d).

Females from low income areas recorded death rates that were 50% higher than those from affluent areas. People from low income areas aged between 25 and 64 years were more likely when compared with those from affluent areas to record their health as poor. They were also prone to ingesting alcohol in harmful quantities, smoking and suffering from hypertension (South Australian Council of Social Services, 2008). The general survey showed that people from affluent areas were better placed to access healthcare than their counterparts in the low income areas. This is an evidence of the disadvantaged status of the people in low income areas regarding access to health services and their health in general. Generally, people from low income areas are more vulnerable to ill health than those from affluent areas (Southern Public Health Unit Network, n.d).

Early Life Factors and Genetics

Early life is characterised by many health risks that are likely to affect our general health throughout our life. The quality of the environment within which a child lives and grows from time of birth until early childhood determines their level and pace of brain stimulation and brain development (South Australian Council of Social Services, 2008). Brain development is vital in school performance and achievement. If the baby transits through the growth period well and in the right way and undergoes the brain development stage properly, then they are likely to possess certain qualities affecting their health status. These qualities are considered to be the set of measurements for the child’s economic, social, and educational and health related behaviour patterns as they attain adulthood (Peterborough County-City Health Unit, 2009).

A child who is born to parents who are high income earners is likely to access quality health care in their childhood. This will determine the status of their health in adulthood. This is as opposed to children from poor families who cannot access preventive services such as immunisation. Children from affluent families are also likely to access quality education, which will in turn inform their selection of quality health care services in adulthood.

Other factors such as genetic inheritance, gender, growth, aging and the functioning of individual’s physiology also determine their health status. These factors influence how an individual develops and the medical challenges that they are likely to face in their life. For example, a person from a family predisposed to diabetes is likely to inherit this condition. As such, it is important for the right foods with the right nutritional value to be administered to these individuals in order to help them manage the disease (South Australian Council of Social Services, 2008). When individuals are from low income areas, they are less likely to receive this kind of attention. They may not access the correct health care, hindering them to attain their full potential. Individuals from affluent areas enjoy quality care, growing and developing when being closely monitored for abnormal behavioral patterns (Peterborough County-City Health Unit, 2009).

If growth of such individuals is not closely monitored, there might be solvable problems that may develop into complex problems requiring more expenses to manage. Those in low income areas are advised to undergo regular medical check-ups. Growing up with good health is not a simple task. From the discussion above, it is obvious that genetic factors are also determinants of health. They determine many attributes of an individual’s health. The only problem is that they can not be changed to fit a particular situation (Richard & Michael, 2003).

The social determinants of health are related in many ways, as already indicated. A clear understanding of the social determinants of health yields an analysis of the relationship between all the factors. An example is how income availability affects the education levels. It is well known that education levels of individuals are dependent on their social status. Some families cannot afford to send their children to school. This contributes to low education levels which in turn hinder the family from embracing healthy living conditions. Knowledge is power and lack of it results to an ignorant existence. Uneducated individuals or families will not be cautious of the environment. They are not aware that it contributes to their well being. Income availability also determines access to quality health care (Personal Communication, May 12th, 2010).

The families from low social class are mostly employed as casual laborers. The ability of individuals to secure sufficient sources of income contributes to their good health. They are able to send their children to school and also they can access quality health care services. If individuals are secure in their work places they, will not be stressed.

The government also needs to contribute to the health of the community. This is by providing benefits such as medical aid or insurance, ensuring equality and stability. This is together with making sure that the citizens are not exploited at their work places. Through formulated policies, the government can ensure the existence of quality social determinants of health (Personal Communication, May 12th, 2010).

The health care services are usually so expensive, hindering access to these facilities. In order for families from low social status to access these services, they have to rely on the goodwill of community based agencies.

Models of Social Determinants of Health

The neo materialistic approach suggests that the challenges and conditions of life are important for health but they are unequally distributed. This approach helps in understanding why there are economic disparities between different areas and sections of the population. When one compares themselves to those who are in another social status it leads them to attempt to eradicate these feelings, taking on more employment opportunities that threaten their health (Raphael, 2004). They may also adopt health-threatening behaviours such as alcohol abuse and tobacco. The social comparison approach also has the communal level of determining that the more people are separated economically there are weaknesses of bonding in the social structure. This bonding is important since social cohesion is a social determinant for health. These create weakness in the communal structures that are determinants of health for example public education, health, and social programs (Raphael, 2004).

For a community to have good health, members must study the social determinants that critically influence their health. Education is a source of knowledge on preventive measures undertaken to prevent illnesses. Other conditions such as early life factors and genetics must be understood in order for community members to be conversant with how it affects their health (Personal Communication, 2010).

Policy Decisions that Shape the Quality of These Social Determinants of Health

Overall fund transfer is the redirection of income generated by the economy to the various sectors of the society. Social and health services are among the various beneficiaries of this money transfer. The percentage allocated to health and social services is determined by the Organization for Economic Cooperation for Development [OECD] (Raphael et al, 2006). OECD usually ensures that at least 21 percent of the GDP is spent on the social services. There are three main areas identified as funds transfer avenues. The first is pensioners’ scheme which is allocated about eight percent of the total amount (Southern Public Health Unit Network, n.d). Health is allocated about 5.5 percent and income transfers to the working population around 4.7 percent (Southern Public Health Unit Network, n.d).

For example, Canada spends 18.8 percent of GDP on her fund transfers to cater for social services (Doshi, 2010). Health is allocated 6.3 percent, income support 3.0 percent, pensions 5.5 percent and finally social services 4.0 percent (Doshi, 2010). When compared with other nations under the auspices of Organization for Economic Cooperation and Development, Canada is one of the countries that spend the least on social and health services. This country has a government operated program of health for all. This program aims at improving the health of the citizens of Canada (Southern Public Health Unit Network, n.d).

The income support programme is meant to support the non-working population in the country. These are for example the benefits that help low income families to stay out of poverty. These are given as family benefits, wage subsidies and child support. There are stringent qualifications to these benefits and sometimes most citizens are not eligible to this program, making it discriminative. The social services include garbage collection, clean water supply services and electricity. These are provided for by the government (Raphael et al, 2006).

In Canada, the policies about the well being of the individual are to some extent similar to those in the United States of America. For example, they have a “residualist” approach to social welfare and service provision. It states that the individuals are responsible for their well being. The responsibility of an individual faced with difficulties lies with their family. Community based agencies can provide help when necessary (Glenn & Glousner, 2003). This approach has been a major cause of high rates of poverty in the community, as opposed to areas where government is committed to service provision. This leaves the role of poverty reduction to market forces which may not be an effective way of fighting poverty. This results to poor social services that in the long run negatively affect the social determinants of health (South Australian Council of Social Services, 2008).

Public policies are the extent to which the governments are committed to poverty reduction (Raborough, 2009). Poverty levels in Canada are considered to be low but in the real sense the rates are higher. The weak social programs in Canada are responsible for the abject poverty because many families are vulnerable to poverty. The elderly are secure for the time being because of the public policies in place such as pension schemes. This has maintained poverty rates for the elderly below that of the younger generation. However, poverty rates in the country differ because of the different orientations of social service provisions (Raphael et al, 2006).

Measures To Improve the Quality of These Social Determinants of Health

To improve public health and the quality of social determinants of health requires a collaborative approach by various agencies. Examples of such efforts are detailed below:

  • Keeping track of and monitoring the health determining social and environmental conditions and trends. Programs to improve the social determinants should be developed.
  • Promoting awareness of the social determinants and other conditions that affect health.
  • Advocating for health oriented policies and programs in non-health sectors and seeking support for the programs.
  • Involving the communities in planning, implementing and evaluating initiatives to address health determinants and drawing all inclusive plans.
  • Ensuring that community public health planning is part of the efforts within public health services and other agencies and sectors to ensure coordination of all activities at the local level.
  • Application of health impact assessment to include the social determinants of health and to assess the impacts of policies and programs to the health sector.
  • Coordination with other local organizations to improve and integrate existing services and structures.
  • Developing, implementing and evaluating programs which build on social effort and cooperation and contribute to the people’s sense of control and efforts.
  • Advocating for resources to support integration and kick starting of public health practices.
  • Ensuring continuous research for further development and understanding of the dynamics of public health and identification of areas where efforts are required to improve the situation.
  • Building a formidable workforce with skills in research, evaluation and reporting to help in the community and local programs (Southern Public Health Unit Network, n.d).

Why it is Difficult for Governments to Address These Issues

The Canadian government, for example, adopts a “residualistic” approach to the issue of poverty where individuals’ difficulties are the responsibilities of their families or community based programmes. This makes it difficult for the fight against poverty to succeed. Therefore, efforts to ensure governments steps in to reduce poverty and improve the social determinants of health may prove to be hard given the fact that its policy is already set (Glenn & Glousner, 2003).

Most governments use the poverty rates as an indicator of progressive public policy. According to the Luxemburg income study, Canadians fair better than other citizens when one compares the poverty rates (Glenn & Glousner, 2003). The real values on the ground are however not as reflected by the study. There are many people living in abject poverty than the studies indicate. This makes the government hesitate in undertaking any programs to change the situation since they believe they are on the right track (Glenn & Glousner, 2003).


The social health determinants are an indicator of the serious problems in health of the community. The indicators prod governments and other stakeholders to shift their focus from the traditional view of health as the state of being of an individual. There is need to adopt a broad focus that highlights that the environment and well being of an individual are combinations of many factors. This will help in solving many health related problems.


California News Reel. (2007). Unnatural causes: Is inequality making us sick? Web.

Doshi, M. (2010). Inclusive education as a social determinat of health. New York: Free Press.

Glenn, R. W., & Glousner, G. (2003). Social determinants of health: The solid facts. Denmark: World Health Organization.

Peterborough County-City Health Unit. (2009). Social determinants of health. Web.

Raborough, N. O. (2009). The interplay between the social and health factors of communities. National Health Quarterly, 2(3), 28-29.

Raphael, D. (2004). Social determinants of health: Canadian perspective. Toronto: Canadian Scholars’ Press INC.

Raphael, D., Bryant, T., & Marcia, R. (2006). Staying alive: critical perspectives on health, illness, and health care. Toronto: Canadian Scholars’ INC.

South Australian Council of Social Services. (2008). The social determinants of health: The SACCOS Information Paper. South Australia: Unley.

Southern Public Health Unit Network. (n.d). Social determinants of health: Income fact sheet.

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