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Social Determinants of Health

All over the world, major health policies are being redefined around what is called “Social Determinants of Health”. As a sign of the ongoing realignment, the World Health Organization (WHO) has received the final report of the work of the Commission on the Social Determinants of Health. These determinants are the conditions that allow us to be and maintain our health.

You might be saying to yourself, “How do I get to know all this?” As for lifestyle habits, I’m already aware of them, for the rest, is there something practical? Yes, there is something practical, but no quick fix. On the other hand, it could give you ideas that you had never thought of to improve your lot. And that should be part of the general culture of every citizen.

What are the Social Determinants of Health?

Social Determinants of Health are all factors that influence the state of health of the population, without necessarily being the direct causes of particular problems or diseases. The Social Determinants of Health are associated with individual and collective behaviors, living conditions, and environments.

According to the WHO definition, the Social Determinants of Health are the “personal, social, economic and environmental factors that determine the state of health of individuals or populations”.

The Dictionary of epidemiology gives a close definition: “a determinant is a factor, whether it is an event, a characteristic, or any other definable entity, which causes a change in the state of health. Or some other defined characteristic”

These definitions underlie a cause-and-effect relationship between the determinant and health status. The determinant is one of the key concepts on which the principle of public health intervention is based. Indeed, it is by acting on one or more determinants that we will influence the state of health of the population.

In 2007, some organizations proposed a list of 12 Social Determinants of Health. They are,

  1. Income Level and Social Status
  2. Social Support Networks
  3. Education and Literacy
  4. Employment and Working Conditions
  5. Social Environments
  6. Physical Environments
  7. Personal Health Habits and Adaptability
  8. Early Childhood Development
  9. Biological and Genetic Heritage
  10. Health services
  11. Gender
  12. Culture and Lifestyle

In theory, the equation is simple. The more positive “determinants” a person has, the better their chances of being healthy.

12 Social Determinants of Health

The Social Determinants of Health are the factors that influence the quality of health of a population. In another way, the state of the Social Determinants of Health reflects the development of a society and the real freedoms enjoyed by its members.

For example, the freedom not to die from a preventable disease, the freedom to eat properly, the freedom to find adequate housing, the freedom to read and write, the freedom to travel, to rest, jogging, etc.

Let’s know the details of the 12 Social Determinants of Health.

12 Social Determinants of Health
12 Social Determinants of Health

1. Income Level and Social Status

The level of income of individuals, households, or the family was the classic indicator used in the first investigations on social inequalities and their effect on health, however, several studies have discredited its validity to sufficiently explain this relationship. Some studies show that, after a certain level of average income per person, increases in income do not seem to improve the health level of the population, at least significantly.

Social status determines significant health inequalities in the population. These inequalities are often evident, especially in clinical practice. However, defining and measuring these inequalities is not always easy. Social status can be defined as access to power, prestige, wealth, etc.

2. Social Support Networks

The social environment, the support of relatives and family, and the help of friends make it possible to overcome health-related difficulties and thus contribute to better health.

A quite influential area is that of the family. A person with family problems tends to be more emotionally unstable, as well as people with few, less sociable friends who live in toxic relationships.

3. Education and Literacy

Education is another widely used material factor for the study of health inequalities. The educational level has direct and indirect repercussions on people’s health status, by operating as an element of reinforcement and protection throughout their lives.

As a reinforcement, education contributes to the choice of lifestyles and behavior favorable to health and, simultaneously, it enables access to better jobs and life opportunities that protect people from health risks.

Education is a relatively easy factor to measure through indicators such as the number of complete years of study, the maximum level of study achieved, or the degrees obtained.

4. Employment and Working Conditions

The fourth material factor used is the occupation of the people, that is, the position of the individual within the social structure, which contributes to protect him from certain occupational risks, facilitates access to health resources, contributes to producing different levels from psychological stress and can influence their behavior or the adoption of healthy lifestyles.

In advanced societies, occupation is the main criterion to explain the social stratification and categorization of the different socioeconomic groups, where esteem and social approval depend, to a large extent, on the type of work that people have, as well as on their professional training and achievements.

However, the certain analytical utility of this determining factor, its measurement faces difficulties to consider in all research work, among others: classifying those who are engaged in domestic work or are in retirement condition and also, the existing differences in the compensation paid for the same job and often due to gender or race.

5. Social Environments

People with an unfavorable socioeconomic position are in poorer health than people whose socio-economic position is favorable.

Since the mid-nineteenth century, numerous investigations revealed the significant impact that the conditions of the environment where they live, study, work, or age have on the health of individuals, which they concern elements such as access to basic services in the field of sanitation, clean water, and waste disposal.

To measure environmental factors, a very broad set of useful indicators is used such as measures related to air quality (quantity of suspended particles of lead, ozone, or carbon dioxide, for example), water quality (from access to piped water to measurement of the turbidity or pH of the liquid); the number of road accidents and mortality from this cause, an average value of homes, number of cases of family violence, percentages of unemployed in the study area, among others.

It is also related to the socio-economic factor since it is said that unemployment and poverty can cause social disintegration, which would increase the risk of suffering stress, depression, and anxiety.

6. Physical Environments

The good health of a population depends on the quality of the air, water, homes and infrastructure, and public roads. Physical factors encompass everything that refers to the environment that surrounds a person to pollution. Among them we can mention the following:

  • The use of aerosols.
  • Noise: a factor that is not considered, but has a relevant influence e.g. the excessive presence of noise, whether at work or home, can cause stress, anxiety, insomnia, and, consequently, hearing problems.
  • Atmospheric pollution.

7. Personal Health Habits and Adaptability

Although it is not taken as something so necessary, physical exercise is very important since it not only prevents obesity but also protects cardiovascular health.

Therefore, the general recommendation is to lead an active lifestyle, not only incorporating exercise routines, but increasing movement, both in the workplace and at home.

In the same way, eating unhealthy foods (such as saturated fat) could increase the risk of heart problems.

People with risky behavior (tobacco, alcohol, drugs, etc.) are at risk of developing more disease and have poorer health than people without risky behavior.

People with coping skills in the face of stressful situations and/ or obstacles in life enjoy better health than people without good coping skills.

8. Early Childhood Development

The development of the child and the situations lived or not, have repercussions on the state of health of the adult person.

The study by stages of life, more than a dimension, is a useful approach for the investigation of social inequalities since it covers social facts outside the individual, which can affect their health condition throughout life, for example, the effect of socioeconomic status during childhood, the presence of specific health conditions upon reaching adulthood.

It is obvious that this approach requires very extensive studies, with a great variety of indicators and, above all, precise and continuous monitoring of the data. The usefulness of the results of this type of work concerns the design of public policies that can influence the future of the health of individuals.

9. Biological and Genetic Heritage

Biological factors are inherent to each individual being and in most cases cannot be controlled. They can make an individual more or less prone to presenting a certain disease and are considered to influence up to 20% in the general state of health.

Genetics heritage is one of the most difficult to change, since it is directly related to each individual, so it is different in each case.

While it is true that there are factors that predispose to suffering a disease, lifestyle also influences. Specifically, it is about 20%; therefore, it is very important to maintain a good diet and exercise.

The healthier you try to be, the less risk there is of suffering from any ailment.

10. Health Services

People with easy access to health services have better health than people with difficult access to health services.

In recent years, barriers to access to health services appear as one of the causes of greater explanatory interest about the differences in health between social groups, mainly because to eliminate them, consistent public policies are established.

Although the level of income is adequate, one has sufficient knowledge and lives in a healthy environment, the effect of access gaps is true, if medical services are not available or these are deficient when diseases appear.

Not only will social groups see their good health diminish, but they will also live in an environment much more risky for life.

The indicators used are the number of doctors and nurses available in the study area, as well as the number of countable beads or the percentage of social security beneficiaries.

11. Gender

Men and women are not subject to the same risk of disease depending on their age. Beyond the specific ailments of each gender, common diseases do not always occur equally if the person is of one or the other sex. Neither drugs have to act the same in a man as in a woman.

Recent research has revealed the crucial differences between men and women in cardiovascular disease, cancer, liver disease, osteoporosis, and in the area of ​​pharmacology.

Medical science still knows very little about gender-specific differences in disease, particularly when it comes to symptoms, their link to social and psychological factors, and the implications of these differences for treatment and prevention.

12. Culture and Lifestyle

Cultures, customs, traditions, and beliefs influence values ​​and feelings about health. The behavior of people throughout their lives, faced with different risks to their health, is one of the most studied determining factors since the second half of the 20th century. Smoking, consuming alcohol, eating poorly nutritious food, or maintaining low levels of physical activity are practices that directly damage the health and life perspective of individuals and that they freely choose, hence the importance of their knowledge in predicting the future state of their health and the implementation of appropriate prevention and cure policies.

This factor is usually measured through indicators such as consumption or not of cigarettes or alcohol, the number of cigarettes or the daily amount of drink consumed, the level of caloric consumption, or the time devoted to physical activities. And it is said that leading a healthy lifestyle is individual and, accounts for approximately 45% of the factors.

Change Your Habits and Protect Your Health

Although some factors are unavoidable, there are others that, as already noted, can be changed with effort. If you need help, don’t hesitate to consult your doctor or your psychologist.

With a little bit of strength and patience, you can change certain negative habits. Taking care of your health is essential to have a long and profitable life.

Final Thoughts

In everyday life, if you can rate your health (is it excellent, good, average, bad, or very bad?) And the state of the Social Determinants of Health in your life, you can probably make a connection between both. It is well known that each of us is a fairly good judge of our state of health and that our assessment has strong predictive value.

My writing on Social Determinants of Health always starts or ends with a question. By the end of this series, if you have answered the questions, you will have a fairly clear picture of the state of the Social Determinants of Health in your life. This will help you better understand why you rate your health the way you do and what you should pay more attention to.