8.1 Social determinants of health

Social determinants of health are non-medical factors that shape our well-being. They include where we're born, grow up, work, and live. These factors create health inequities, affecting everything from access to healthcare to our daily habits and choices.

Understanding social determinants is key to improving public health. They impact health outcomes throughout our lives, contributing to disparities between communities. By addressing these factors, we can create more effective strategies to promote health and prevent disease for everyone.

Social Determinants of Health

Definition and Significance

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• Social determinants of health encompass non-medical factors influencing health outcomes
• Include conditions in which people are born, grow, work, live, and age
• Span social, economic, and environmental factors shaping individual and community health
• World Health Organization (WHO) recognizes social determinants as key drivers of health inequities
• Impact health outcomes cumulatively and interconnectedly throughout life course
• Influence morbidity, mortality, and quality of life across populations
• Understanding social determinants crucial for developing comprehensive public health strategies

Impact on Population Health

• Create complex pathways affecting health outcomes
• Contribute to health disparities between and within countries
• Influence access to healthcare resources and services
• Shape health behaviors and lifestyle choices
• Affect exposure to environmental health risks (air pollution, unsafe water)
• Impact mental health and well-being (stress, social isolation)
• Determine opportunities for health promotion and disease prevention

Key Social Determinants

Socioeconomic Factors

• Socioeconomic status (SES) fundamentally influences health outcomes
  • Encompasses income, occupation, and social class
  • Affects access to resources (healthy food, safe housing)
• Education level linked to health literacy and behaviors
  • Higher education generally associated with better health outcomes
  • Impacts understanding of health information and decision-making
• Employment conditions affect physical and mental health
  • Job security influences stress levels and overall well-being
  • Workplace safety determines occupational health risks
• Income inequality contributes to health disparities within communities
  • Affects access to healthcare services and preventive measures
  • Influences living conditions and lifestyle choices

Environmental and Social Context

• Neighborhood and built environment impact health and well-being
  • Housing quality affects respiratory health and safety
  • Transportation systems influence access to healthcare and job opportunities
  • Green spaces promote physical activity and mental health
• Social and community context shape individual and population health
  • Social support networks buffer against stress and improve resilience
  • Discrimination contributes to chronic stress and health disparities
  • Community cohesion fosters collective efficacy for health promotion
• Food security and access to nutritious options essential for health
  • Food deserts limit availability of healthy food choices
  • Malnutrition and obesity linked to poor food environments
• Environmental hazards disproportionately affect certain communities
  • Industrial pollution often concentrated in low-income areas
  • Climate change impacts vulnerable populations more severely

Healthcare Access and Quality

• Availability of health services crucial for population health
  • Geographic distribution of healthcare facilities affects access
  • Telemedicine expanding reach in underserved areas
• Affordability of healthcare determines utilization patterns
  • Out-of-pocket costs can deter seeking necessary care
  • Health insurance coverage influences preventive care usage
• Quality of health services impacts health outcomes
  • Cultural competence of providers affects patient-provider communication
  • Continuity of care improves management of chronic conditions
• Health literacy influences navigation of healthcare systems
  • Understanding medical instructions impacts treatment adherence
  • Ability to advocate for oneself in healthcare settings

Social Determinants and Health Disparities

Mechanisms of Disparity Creation

• Social determinants contribute to systematic health differences between groups
• Intersectionality of multiple determinants compounds health disparities
  • Race, gender, and SES interact to create unique health challenges
  • LGBTQ+ individuals face compounded disparities due to discrimination and social stigma
• Socioeconomic gradients demonstrate health improvements with increasing status
  • Income-related health disparities evident in life expectancy differences
  • Educational attainment correlates with better health outcomes across populations
• Racial and ethnic disparities linked to historical and ongoing systemic inequalities
  • Residential segregation limits access to health-promoting resources
  • Discrimination in healthcare settings affects quality of care received

Patterns and Manifestations of Health Disparities

• Geographic variations in health outcomes reflect social and environmental differences
  • Rural-urban disparities in access to specialized healthcare services
  • Neighborhood-level differences in life expectancy within cities (up to 20-year gaps)
• Life course perspective highlights intergenerational patterns of health disparities
  • Early childhood experiences shape lifelong health trajectories
  • Maternal health during pregnancy influences offspring health outcomes
• Chronic disease prevalence varies significantly across population groups
  • Higher rates of diabetes and hypertension in certain racial/ethnic minorities
  • Socioeconomic status inversely related to cardiovascular disease risk
• Mental health disparities reflect social and economic inequities
  • Higher rates of depression in low-income populations
  • Limited access to mental health services in rural areas

Strategies for Addressing Social Determinants

Policy and Systemic Approaches

• Health in All Policies (HiAP) integrates health considerations across sectors
  • Urban planning policies promote walkable communities and green spaces
  • Education policies address school nutrition and physical activity
• Intersectoral collaboration essential for comprehensive strategies
  • Healthcare and housing sectors collaborate on healthy homes initiatives
  • Transportation and health departments partner to improve access to medical care
• Policy interventions address structural determinants at population level
  • Minimum wage laws impact income-related health disparities
  • Affordable housing policies reduce housing insecurity and associated health risks
• Health impact assessments (HIAs) evaluate potential health effects of policies
  • Used to assess transportation projects' impacts on air quality and physical activity
  • Applied to urban development plans to ensure health-promoting environments

Community-Based and Targeted Interventions

• Community-based participatory research (CBPR) engages community members
  • Ensures culturally appropriate interventions (tailored diabetes prevention programs)
  • Builds community capacity for addressing local health challenges
• Place-based initiatives focus on improving specific geographic areas
  • Neighborhood revitalization projects address multiple determinants simultaneously
  • Community gardens promote food security and social cohesion
• Targeted interventions address needs of specific populations
  • Mobile health clinics reach underserved rural communities
  • Cultural competency training for healthcare providers reduces disparities in care quality
• Monitoring and evaluation crucial for assessing intervention effectiveness
  • Longitudinal studies track long-term impacts of early childhood interventions
  • Community health needs assessments guide resource allocation and program development