Social Determinants of Health (General)
The circumstances in which a person is born, lives, works and plays have as great an impact on health as genetic heritage, lifestyle choices and access to medical care.
Research from many disciplines now confirms what many have long suspected: social, economic and environmental factors have profound effects on health, quality of life, and life expectancy. Serious efforts to reduce health inequity must address these factors.
Minnesota is widely regarded as one of the healthiest states in the nation. But this general description of our state’s good health masks alarming patterns across socioeconomic, racial and ethnic groups. Sizable disparities in health status between the white population and populations of color and American Indians have been documented for overall health indicators, incidence of specific diseases and many risk factors.
Social determinants and health inequities
Pronounced disparities in health status mirror inequities on many broader social and economic indicators. For example, rates of child and adult poverty among populations of color and American Indians in Minnesota are three to four times that of whites, and whites receive almost twice as much income per capita. Similar disparities are evident in rates of unemployment, high school graduation, home ownership and housing.
The importance of these findings is heightened by several trends, including:
- Increasing racial and ethnic diversity statewide
- Dramatic escalation of health care costs at a time of enormous national, state and local budget deficits
- Greater recognition that popular public health interventions focused on individual behavior change are limited. To reach their potential effectiveness, they need to be combined with an attention to a broad array of factors that shape individual choices, opportunities and risk exposures.
The Institute of Medicine stresses the importance of improving social, economic and environmental factors this way, “Interventions to improve access to medical care and reduce behavioral risk have only limited potential for success if the larger societal and economic context in which people live is not improved.”
Defining social determinants of health
The social environment encompasses social and economic factors such as income, education, employment status and working conditions, social networks and community cohesion. The physical environment includes the natural environment (clean air, water and soil), the built environment (land use patterns, zoning and community design) and living conditions such as the availability of safe and affordable housing, transportation and nutritious foods.
Income and education are among the most potent determinants of health. Simply stated, the rich are healthier than the middle class, who are in turn healthier than the poor. At a community level, disease and death rates are higher in residential areas that have the greatest gap in income between the rich and poor.
An “upstream” orientation does not diminish the importance of delivering quality, affordable and timely health services or of addressing behavioral risks such as smoking and physical inactivity. Rather, this shift in focus has potential to lesson the burden on these critical services.
Growing recognition of the importance of addressing social determinants of health is reflected in the current focus of public health in western Europe, Canada, Australia and New Zealand. This recognition is beginning to influence policy and practice in different communities across the U.S. Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC), states, “One major task that CDC is intending to address is on making sure that we invest the same kind of intense resources into keeping people healthier or helping them return to a state of health and low vulnerability as we do to disease care and end of life care.”
Social and economic factors influence opportunities, exposures, decisions and behaviors that promote or threaten health. Effective “upstream” action to promote population health and eliminate health inequities will require knowledge of the factors that most clearly affect health, and use of interventions most likely to produce measurable change.
America's Tomorrow, Equity is the Superior Growth Model
This PolicyLink report describes the components of an equity-driven growth model and acknowledges that a true social movement is needed to achieve equityDownload (pdf)
A Call to Action: Advancing Health for All through Social and Economic Change
This April 2001 report, which may be downloaded from the Minnesota Department of Health’s Web site, is a multi-disciplinary, inter-sector Call to Action produced by the Social Conditions and Health Action Team of the Minnesota Health Improvement Partnership (MHIP).Download (pdf)
Beyond Health Care: New Directions to a Healthier America
Recommendations from the Robert Wood Johnson Foundation Commission to Build a Healthier AmericaDownload (pdf)
Broadening the Focus: The Need to Address the Social Determinants of Health
Paula A. Braveman, MD, MPH, Susan A. Egerter, PhD, Robin E. Mockenhaupt, PhD, MBADownload (pdf)
Closing the gap in a generation: Health equity through action on the social determinants of health
The Final Report of the WHO Commission on Social Determinants of Health (CSDH). The CSDH supports countries and global health partners to address the social factors leading to ill health and inequities. It draws the attention of society to the social determinants of health that are known to be among the worst causes of poor health and inequalities between and within countries. The determinants include unemployment, unsafe workplaces, urban slums, globalization and lack of access to health systems.Link to Executive Summary
The Community Guide's Model for Linking the Social Environment to HealthDownload (pdf)
Determinants and Critical Pathways Charts
Explore the interrelationships of "upstream" and "downstream" influences on health through charts from Healthy People 2010, the Community Guide and the Prevention Institute.Download (pdf)
Eliminating Health Disparities: The Role of Primary Prevention
This paper from The Prevention Institute describes how health disparities can be reduced through system-based prevention strategies that address the underlying factors influencing health.Download (pdf)
Growing the Field of Health Impact Assessment in the United States: An Agenda for Research and Practice
Article from the February 2006 American Journal of Public Health that looks at issues associated with advancing the use of health impact assessment methods by local health departments, planning commissions and other decisionmakers in the United States.Download (pdf)
The Influence of Community Factors on Health: An Annotated Bibliography
More than 150 entries of research on how community factors affect health, developed by PolicyLink.Link to report
Katrina's Window: Confronting Concentrated Poverty Across America
This October 2005 report by the Brookings Institution discusses the impact of concentrated poverty in the nation's 50 largest cities. It stresses that society possesses the tools to enable public and private-sector leaders to create neighborhoods of choice and connection, leading to social and economic mobility for individuals and ultimately creating healthier communities.Link to report
Leadership & Race - How to Develop and Support Leadership that Contributes to Racial Justice
Leadership programs can help solve racial inequalities in access to education, healthcare, income and wealth. But according to this new report released by the Leadership Learning Community and other thought leaders in the leadership development and racial equity fields, many current approaches to leadership development actually maintain and promote racial inequalities.Download (pdf)
More Than a Message: Framing Public Health Advocacy to Change Corporate Practices
Written by Lori Dorfman, DrPH; Lawrence Wallack, DrPH; and Katie Woodruff, MPH. This article describes how two frames, market justice and social justice, influence public dialogue on the health consequences of corporate practices.Download (pdf)
Overcoming Obstacles to Health
This RWJF report presents new evidence of disparities in health across income and education groups and estimates the economic costs of these disparities. It also offers a framework for finding solutions by applying current knowledge about the underlying causes of social disparities in health.Link to report
Reducing Health Disparities by Focusing on Communities
Collaborative 2002 report published by PolicyLink and the California Endowment addresses social determinants of health, lessons from field and strategies to eliminate health disparities.Download (pdf)
Social Cities - Grattan Institute 2012
What is social connection, why is it important, and what does it have to do with cities? A report written by Jane-Frances Kelly, Grattan Cities Program Director. March 2012Download (pdf)
Social Determinants of Health Inequalities
Article by Michael Marmot, chariman of the Commission of Social Determinants of Health of the World Health Organization, 2005.Download (pdf)
Spending More and Getting Less for U.S. Health Care: What We Can Do to Improve Health Outcomes
In the March 2006 issue of Minnesota Journal, published by the Citizens League, author Jan Malcolm discusses the implications of health spending on individual medical care versus spending on social determinants of health in communities.Download (pdf)
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
This brief summary of the Institute of Medicine Unequal Treatment report describes how racial and ethnic disparities may emerge and summarizes relevant findings and recommendations to help health care professionals provide high quality care for all patients.Link to article
Why Place Matters
This joint report by PolicyLink and The California Endowment, helps explain the relationship between community conditions and health, analyzes the connections among the environmental factors that contribute to a healthy community, and identifies both protective and negative environmental effects on community health.Link to report