The determinants of health and wellbeing are the conditions in which people are born, grow, live, work and age. These conditions determine a person's chances of maintaining good health. They are sometimes referred to as 'the causes of the causes', as it is recognised health is not simply about behaviour or exposure to risk, but how social and economic structures shape the health of populations.
The figure below shows the layers of influence on people's health and wellbeing. They may start with individual factors and extend to lifestyle and environment factors, including social, cultural and economic factors.Factors beyond Australia's boundaries also have a significant impact on our health and wellbeing. These include the integration of the global economy, financial markets and trade, wide access to media and communications technology and environmental degradation due to irresponsible use of resources.
Climate change will have a major impact on the health and wellbeing of populations into the future, especially vulnerable groups.
The social determinants of health
Social factors are important determinants of health because they create inequitable differences in health outcomes. The World Health Organization has identified 10 social determinants of health:
- the social gradient
- early life
- social exclusion
- social support
Of these 10, the single strongest predictor of our health and wellbeing is our position on the social gradient (or the 'social ladder'). Whether measured by income, education, place of residence or occupation, those people at the top of the gradient have the most power and resources, and on average live longer and healthier lives. Those people at the bottom have the least power and usually run at least twice the risk of serious illness and premature death as those near the top.
Where we are promoting health and wellbeing we need to focus on the issues most relevant to people's lives. For example, if a person is struggling to survive financially, is unemployed or in poor housing, then changing individual risk behaviours such as smoking, nutrition or physical activity may be a low priority for them. For people most vulnerable or those with complex needs, the most immediate need is usually to focus on the social determinants of health.
Essential to addressing the determinants of health is a cross-sectoral and cross-departmental approach. See Partnerships for further information on these approaches.
Protective and risk factors
Protective factors are described as health-promoting behaviours, healthy conditions and environments, psychosocial factors and effective health services. Protective factors for health can have a positive impact on health outcomes. For example, easy access to healthy and affordable food is more likely to lead to eating adequate vegetables and fruit every day, which can help protect against certain cancers, coronary heart disease, overweight and obesity.
Risk factors can have a negative effect on health. They include lifestyle or behavioural risk factors such as smoking, poor nutrition, excessive or risky alcohol intake, physical inactivity and psychosocial conditions such as isolation, low self-esteem and abuse. There are also physiological risk factors such as high blood pressure, high cholesterol and genetic features. Risk factors may also be present as a result of social and environmental conditions such as natural resource depletion, polluted environments and discrimination.
For further information and to apply these principles in your work, view this checklist
Visit the evidence library to find more information about this principle.
To see examples of the Working in Health Promoting Ways Principles of Practice, view the case studies