Health is not simply about behaviour. Social, environmental, economic, commercial, and cultural factors shape our health and wellbeing. These are called the ‘determinants of health’; they are the conditions in which people are born, grow, live, work and age. The determinants of health can create inequitable differences in health outcomes.
One of the strongest predictors 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 on average live longer and healthier lives. People at the lower end of the social gradient have at least twice the risk of serious illness and premature death as those at the top.
Other determinants are stress, early life, social inclusion, work, unemployment, social support, addiction, food, housing, and transport. In Australia, living in rural and remote areas can also be a determinant of health due to isolation from services and older populations living in these regions.
We also need to think about the way we build our cities and towns, grow and distribute our food and advertise products to children as other determinants of health.
The cultural determinants of health are important to understanding and improving the health and wellbeing of Aboriginal and Torres Strait Islander people. These include:
When we promote health and wellbeing, we need to focus on the issues most relevant to people. For example, if a person is struggling, is unemployed or has poor housing, changing behaviours like smoking, poor nutrition or inactivity may be a low priority for them. For vulnerable people or those with complex needs, the most immediate need is usually from the social determinants of health.
Making sure our services and programs are culturally respectful and inclusive is important to help people with their health and wellbeing. We also need to work in partnership with other sectors to address the broader determinants of health.