Social Determinants of Health

 The social determinants of health are the circumstances in which people are born, grow up,
live, work and age, and the systems put in place to deal with illness. These circumstances are in
turn shaped by a wider set of forces: economics, social policies, and politics.

Lets focus on the What & Why …

 “Determinants” of Health (underlying factors – not just causes)
 Risk Factors/Risk Conditions
 Types of factors/conditions that groups of people with the Dz/condition have that people
without don’t have

Determinants
 “things” whose presence are associated with increased chance that Dz/condition will
develop later
 can be environmental, social & behavioral influences – not just individual behavior
 can be modifiable (susceptible to change) or non-modifiable (immutable to change)
 Some (e.g., behavior) more likely to be under control of an individual - doesn’t mean it is
easy to change!
 Diet influences health outcome, but is also influenced by access to healthy foods or social
influence
 Modifiable- exercising more, eating less junk food
 Nonmodifiable- age, gender, inhernt biological characteristics, family history, way food is
subsidized

Socioecological model
 Over lifetime, there are many
influences on health outcomes
 Micro
 Small
 Individual characteristics
 Biology of disease
 Innate and nonmodifiable
characteristics
 Behavior
 Macro
 Family
 Social network
 Community
 Living and working conditions
 Broad social, economic, health and
environmental policies

Socio-Ecological Influences on Health

 Micro and macro influences
 Increase likelihood of condition or disease
 Ecological perspective
 Multiple factors and pathways involved
 Social and cultural determinants
 Social status and standing
 Global health influences
 Pollution, poverty and more
 Infant mortality and poverty, resources, access
  Recognizes that there are multiple factors involved

But, It’s Not Easy!

 Behaviors & behavior change are complex – esp. at the population level!
 Don’t exist in a vacuum: have multiple influences … like:
 Environmental Factors
 Social Factors
 Political Factors
 Organizational Factors
 Economic Factors
 Not enough time
 Neighborhood safety
 Lack of accessible resources

Multicausation Disease Model

 A model that explains the onset of disease caused by more than one factor
 Ex.- CHD more likely in persons who:
 are older,
 smoke,
 do not exercise,
 are overweight,
 have high blood pressure,
 have high cholesterol,
 have familial history of CHD

Environmental health
 The science and practice of preventing human injury and illness and promoting well-being by 
o identifying and evaluating environmental sources and hazardous agents and
o limiting exposures to hazardous physical, chemical, and biological agents in air,
water, soil, food, and other environmental media or settings that may adversely
affect human health.
Sources of Toxins
 Environmental- air, water
 Occupational- coal miners,
 Therapeutic- chemotherapy, drugs for disease treatment
 Dietary/Food
 Accidental
 Household- Clorox, bleach
 Nature (e.g., animal, plant)-
 Deliberate…- 9/11 attack