THE

DETERMINANTS OF
1
HEALTH
• MODULE 1 PART 2
• Introduction and the Determinants of Health
1 LEARNING OBJECTIVES

Explain the concepts of health

1 and well-being

Recognize the responsibility of states to uphold the

2 health of their population

Identify the socioeconomic, biological and

3 behavioural factors that influence health

Explain the social determinants

4 of health
1 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.
1 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
1 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
1 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.
 THE SOCIAL DETERMINANTS
1 OF HEALTH

• Source: Dahlgren G and Whitehead M (1991)

Policies and strategies to promote social equity in
health. Stockholm, Institute of Future Studies.
 SOCIAL DETERMINANTS OF HEALTH
1 CONCEPTUAL FRAMEWORKS

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

INTERSECTIONALITY: SOCIAL AND ECONOMIC INEQUITIES,

GENDER, SEXUALITY, ETHNICITY, DISABILITY, MIGRATION

STRUCTURAL DRIVERS CONDITIONS OF DAILY LIFE

Political, Social, Cultural and Early Life and Education

Economic Structures Working Life
Natural Environment,
Older People
Land and Climate Change
Income and Social Protection HEALTH EQUITY
History and Legacy,
Ongoing Colonialism, Violence AND DIGNIFIED
Structural Racism LIFE
Environment and Housing

Health Systems

TAKING ACTION
Governance
Human Rights

Source: Pan American Health Organization. Just Societies: Health Equity and Dignified Lives. Report of the Commission of the Pan American
Health Organization on Equity and Health Inequalities in the Americas. Washington, D.C.: PAHO; 2019.
1 ACTION RECOMMENDATIONS

Global Commission on PAHO Equity

SDH (2008) – Commission (2019) –
3 overarching 12 recommendations
recommendations
 PRIORITY RECOMMENDATIONS:
1 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

2 Tackle the inequitable distribution of power, money and resources:

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
 PRIORITY RECOMMENDATIONS:
1 PAHO COMMISSION

The 12 recommendations include priority objectives

and specific measures in the following general categories:

STRUCTURAL DRIVERS: INEQUITIES IN POWER, MONEY, AND RESOURCES

Achieving equity in political, social, cultural, and

1
economic structures

2 Protecting the natural environment, mitigating climate

change, and respecting relationships to land

3 Reversing the health equity impacts of ongoing

colonialism and structural racism
 PRIORITY RECOMMENDATIONS:
1 PAHO COMMISSION

CONDITIONS OF DAILY LIFE

4 Equity from the start: Early life and education

5 Decent work

6 Dignified life at older ages

7 Income and social protection

8 Reducing violence for health equity

9 Improving environment and housing conditions

10 Equitable health systems

 PRIORITY RECOMMENDATIONS:
1 PAHO COMMISSION

GOVERNANCE FOR HEALTH EQUITY

11 Governance arrangements for health equity

12 Fulfilling and protecting human rights

 End of
Module 1 Part 2

Please continue to
Module 2 Part 1