Understanding the determinants of health is about looking at how and where people live, work and play and how this affects their health and behaviours.
The social determinants of health are the conditions of daily living that determine a person’s chances of maintaining good health. They are the conditions in which people are born, grow, live, work and age (Commission on Social Determinants of Health 2008a). The social determinants of health are sometimes referred to as ‘the causes of the causes’, because it is recognised that health is not simply about behaviour or exposure to risk but how social and economic structures shape our health. (Marmot, M 2007)
The diagram below demonstrates the determinants of health as layers of influence, starting with individual factors and extending to aspects of the wider community. (Hetzel D, Page A et al. 2004)
Dahlgren and Whitehead model of health determinants, 1991
The World Health Organisation(Wilkinson, R, Marmot, M (Eds) 2003) identifies ten social determinants of health:
- the social gradient
- early life
- social exclusion
- social support
The single strongest predictor of our health is our position on the ‘social gradient’ (or the ‘social ladder’). Whether measured by income, education, place of residence or occupation, those at the top on average live longer and healthier lives. Those at the bottom usually run at least twice the risk of serious illness and premature death. (Wilkinson, R, Marmot, M (Eds) 2003)
When we are promoting health, we need to focus on the issues most relevant to people’s lives. For example, if a person is struggling to survive financially, changing individual risk behaviours such as physical activity may be a low priority for them. For people who are most vulnerable or those who have complex needs, the most immediate health focus is likely to be influencing the social determinants. (South East Health 2003)
Essential to addressing the determinants of health is a cross-sectoral and cross-departmental approach. See Partnerships for further information on partnership approaches.
Global factors also impact on health. These include the development of the global economy, financial markets and trade. Access to media and communications technology gives us access to world events. For example the knowledge of possible outcomes of climate change is likely to impact the health and wellbeing of populations into the future.
Protective and risk factors
Protective factors can be described in terms of health-promoting behaviours, healthy conditions and environments, psychosocial factors and effective health services. (DHS (Victoria) 2003) Protective factors for health can have a positive impact on health outcomes, for example a lifetime habit of eating adequate vegetables and fruit everyday can help protect against certain cancers, coronary heart disease, overweight and obesity. (DoHA 2004)
Risk factors which can have a negative effect on health include smoking, poor nutrition, alcohol misuse, physical inactivity and psychosocial conditions such as isolation, low self-esteem and abuse (SNAPPs factors). Risk factors may also be present in as a result of natural resource depletion, polluted environments and discrimination or physiological risk factors such as high blood pressure, high cholesterol and genetic features.
Click here for a check list that will help you identify whether your health promotion work is considering the “determinants of health”. It may help to identify any questions you may need to consider.