Determinants of Health

Why This Matters

When you're studying public health, understanding determinants of health is foundational—it's the framework that explains why health outcomes vary so dramatically across populations. You're not just being tested on what these factors are, but on how they interact, reinforce each other, and create patterns of health and disease. Exams will ask you to analyze case studies, identify upstream vs. downstream factors, and explain why addressing one determinant often requires tackling others simultaneously.

These determinants fall into interconnected categories: structural factors, social and community influences, behavioral patterns, and biological characteristics. The key insight is that health isn't just about individual choices—it's shaped by the conditions in which people are born, grow, live, work, and age. Don't just memorize the list; know which category each determinant belongs to and how it connects to health equity, disease prevention, and population-level interventions.

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Structural and Economic Factors

These are the "upstream" determinants—the foundational conditions that shape nearly everything else. When resources are distributed unequally, health disparities follow predictably.

Socioeconomic Status

• Income level directly predicts health outcomes—higher SES correlates with lower rates of chronic disease, longer life expectancy, and better mental health
• Resource access including nutritious food, safe housing, and quality healthcare varies dramatically by economic position
• Chronic stress from financial insecurity triggers physiological responses that increase disease risk over time

Education

• Health literacy improves with educational attainment—educated individuals are better equipped to navigate healthcare systems and interpret health information
• Employment opportunities expand with education, creating a pathway to higher income and better insurance coverage
• Risk behavior rates including smoking and obesity are consistently lower among those with more education

Employment and Working Conditions

• Job security functions as a health determinant—stable employment provides income, insurance, and psychological well-being
• Workplace hazards from chemical exposure to repetitive stress injuries create direct physical health risks
• Unemployment and precarious work generate chronic stress, anxiety, and reduced access to care

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Environmental and Community Factors

The places where people live and the relationships they form create the immediate context for health. Physical surroundings and social connections either protect health or undermine it.

Physical Environment

• Built environment shapes behavior—access to parks, sidewalks, and recreational facilities directly influences physical activity levels
• Environmental exposures including air pollution, contaminated water, and toxic waste disproportionately affect low-income communities
• Housing quality affects respiratory health, injury risk, and mental well-being through factors like mold, lead paint, and overcrowding

Social Support Networks

• Strong social ties buffer against stress—emotional support from family, friends, and community reduces cortisol levels and improves mental health outcomes
• Social norms influence behavior—diet, exercise, and substance use patterns spread through networks via shared expectations
• Social isolation is a mortality risk factor—comparable in magnitude to smoking, with effects on both mental and physical health

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Individual and Behavioral Factors

These "downstream" determinants are the most visible but are heavily shaped by upstream conditions. Individual choices occur within contexts that either enable or constrain healthy behaviors.

Personal Health Practices and Coping Skills

• Behavioral risk factors including diet, physical activity, tobacco use, and alcohol consumption account for a significant portion of preventable disease
• Coping mechanisms determine how individuals respond to stress—adaptive strategies protect health while maladaptive ones (substance use, social withdrawal) compound it
• Health behaviors are socially patterned—they reflect education, income, environment, and cultural context rather than pure individual choice

Access to Healthcare Services

• Availability determines utilization—geographic distribution of providers, clinic hours, and appointment availability all affect whether people receive care
• Affordability creates barriers—cost, insurance status, and out-of-pocket expenses delay or prevent treatment, especially for preventive services
• Quality varies systematically—care quality differs by location, insurance type, and patient demographics, contributing to outcome disparities

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Biological and Identity-Based Factors

These determinants interact with social structures to produce health patterns. Biology matters, but its effects are always filtered through social context.

Genetics and Biology

• Genetic predisposition influences disease risk—conditions like sickle cell disease, cystic fibrosis, and certain cancers have hereditary components
• Age and biological sex create different risk profiles—cardiovascular disease patterns, cancer types, and autoimmune conditions vary by these factors
• Gene-environment interactions mean that genetic risk is often activated or suppressed by environmental exposures and behaviors

Gender

• Gender norms shape health behaviors—masculinity norms discourage help-seeking, while femininity norms may limit physical activity or autonomy
• Healthcare access differs by gender—reproductive health services, insurance coverage, and provider treatment vary systematically
• Gender-based violence creates direct physical harm and long-term mental health consequences, disproportionately affecting women and gender minorities

Culture and Ethnicity

• Cultural beliefs influence health behaviors—dietary practices, attitudes toward medicine, and definitions of illness vary across cultural groups
• Ethnic health disparities reflect structural inequities—differences in outcomes often trace to discrimination, segregation, and unequal resource distribution rather than inherent group characteristics
• Culturally competent care improves outcomes—providers who understand patients' backgrounds achieve better communication, adherence, and trust

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Quick Reference Table

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Self-Check Questions

1. Which two determinants are considered "upstream" factors that influence multiple other determinants downstream? Explain the mechanism by which they exert such broad influence.

2. Compare and contrast how physical environment and social support networks each affect health outcomes. What type of intervention might address both simultaneously?

3. If a population shows high rates of obesity and diabetes, which determinants would you investigate first, and why might focusing only on personal health practices be insufficient?

4. How does the relationship between genetics and culture/ethnicity illustrate the difference between biological and social determinants? Why is this distinction important for public health practice?

5. An FRQ describes a community with limited healthcare access, high unemployment, and poor air quality. Identify which category each determinant falls into and propose one intervention that addresses multiple factors.