Social determinants of health are the factors, oftentimes related to environment or status, that affect the conditions of daily life and one's health. They are the factors that determine a person's vulnerability for disease, but also their ability to gain access to care. They are commonly broken down into six categories: economic stability, education, social and community context, race and gender, health care access, and built environment. There is debate about which of these is most important.
The World Health Organization (WHO) explains that health is influenced by the "circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness." WHO further states that "unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements [where the already well-off and healthy become even richer and the poor who are already more likely to be ill become even poorer], and bad politics."
Social determinants of health include all non-biological factors that influence one's health and quality of life. This consists of: access to health education; community and social context; access to quality healthcare; food security; neighborhood and physical environment; and economic stability. Studies have found that more than half of a person's health is determined by social determinants rather than clinical care and genetics.
Health disparities exist in countries around the world. There are various theoretical approaches to social determinants, including the life-course perspective. Chronic stress, which is experienced more frequently by those living with adverse social and economic conditions, has been linked to poor health outcomes. Various interventions have been made to improve health conditions worldwide, although measuring the efficacy of such interventions is difficult. Social determinants are important considerations within clinical settings. Public policy has shaped and continues to shape social determinants of health.
All types of government can increase health equity in their region. Health is not always the main driver of political policy, but policies still often affect citizens' access to healthcare and health equity. One example of this indirect correlation is in trade markets. The WHO explains that, "Trade policy that actively encourages the production, trade, and consumption of foods high in fats and sugars to the detriment of fruit and vegetable production is contradictory to health policy."
Related topics are social determinants of mental health, social determinants of health in poverty, social determinants of obesity, and commercial determinants of health.
Commonly accepted social determinants The United States Centers for Disease Control and Prevention (CDC) defines social determinants of health as "life-enhancing resources". In the realm of public health, the concept of social determinants of health has emerged as a crucial framework for comprehending the myriad factors that influence an individual's well-being. While medical care and genetics play significant roles, a person's health outcomes are also profoundly shaped by their social, economic, and environmental conditions. Understanding these determinants is imperative for devising effective strategies to address health disparities and promote equitable access to healthcare. Some of the main social factors that shape one's health include socioeconomic status, education, neighborhood and physical environment, social support networks, healthcare access and quality, and economic stability.
According to 2021 findings from the Center for Migration Studies of New York, there is a strong correlation among various social determinants of health. Individuals residing in regions marked by one specific determinant often experience the impact of other determinants as well. These social determinants significantly shape health-promoting behaviors, emphasizing that achieving health equity across populations necessitates a fair distribution of these social determinants among different groups.
A commonly used model that illustrates the relationship between biological, individual, community, and societal determinants is Margaret Whitehead and Göran Dahlgren's model originally presented in 1991 and subsequently adapted by the CDC. Additionally, within the United States, Healthy People 2030 is an objective-driven framework which can guide public health practitioners and healthcare providers on how to address social determinants of health at the community level. A 2024 scoping review that evaluated the intensity and complexity of social needs interventions found limitations exist in scaling them, as the majority of studies have not made causal inferences about individual components.
These social determinants of health have gained wide usage: Income and income distribution; education; unemployment and job security; employment and working conditions; early childhood development; food insecurity;Arenas, Daniel J., et al. "A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity." Journal of general internal medicine (2019): 1–9. || https://doi.org/10.1007/s11606-019-05202-4 Housing; social exclusion/inclusion; social safety network; health care services; Aboriginal status; gender; race; and disability.
The list of social determinants of health can be much longer. A 2019 article by Australian scholar M. Mofizul Islam in Frontiers in Public Health identified several other social determinants, including culture and social norms; media; stigma and discrimination; immigration; religion; and access to broadband internet service. Additional research indicates that social determinants of health can be directly tied to degrees of health literacy. Unfortunately, there is no agreed-upon taxonomy or criteria as to what should be considered a social determinant of health. In the literature, a subjective assessment—whether social factors impacting health are avoidable through structural changes in policy and practice—seems to be the dominant way of identifying a social determinant of health. The increase of artificial intelligence (AI) being used in clinical care raises numerous opportunities for addressing health equity issues, yet clear models and procedures for data characteristics and design have not been embraced consistently across health systems and providers.
Socioeconomic status At the core of the concept of social determinants of health lies socioeconomic status. This category takes into account several subcategories, including employment, housing instability, food insecurity, and poverty. There is a significant difference between health care access for those of a higher socioeconomic status and those of lower socioeconomic status. In particular, those of higher status have better access to healthcare, healthier lifestyles, and improved living conditions. Conversely, those with lower incomes often face barriers to accessing quality healthcare, nutritious food, safe housing, and educational opportunities. The stress of financial instability can also exacerbate health issues. This inconvenience can be passed down to future generations as parents teach their children these habits. Individuals from lower-income backgrounds, especially those with disabilities or chronic illnesses, are also much more susceptible to disproportionate amounts of medical debt after receiving care.
Since 1960, healthcare sustainability in the United States has been decreasing at an exponential rate. The main reasoning behind the decline is the rising cost of healthcare. A very common example of this change is the rising cost of insulin over the years. From the years 2014 to 2019, insulin prices rose by 55%, and even those with a stable medical insurance plan reported a nearly 11% increase in out-of-pocket costs. This unfair pricing of medical care leaves a large portion of the population, those who are of a lower socioeconomic status, unable to afford life saving care.
Education Education is a major factor affecting health, and it has been found that adults with higher levels of education live longer and healthier lives than their less educated peers. Education encompasses a person's early childhood and development, completion of high school, higher education, language and literacy. The healthcare system is notoriously difficult to navigate, even for those who have completed some level of higher education, so for those with language or literacy barriers, it is almost impossible. The lack of transparency and communication between insurance companies, healthcare workers, and patients all contribute to the issue of relaying healthcare needs for these communities. Recent patterns show that education is a principal pathway to financial security, stable employment, and social mobility. However, youth in America face numerous barriers to accessing equal educational opportunities. These barriers limit access to quality health care and further widen existing health disparities.
Limited outreach and education on health within communities has also contributed to poorer health outcomes, especially in underserved communities.With the lack of foundational knowledge about positive care, disease management, or how to navigate healthcare systems, they are less likely to seek timely medical attention or adhere to treatment plans. Research on immigrant populations in rural America has found that limited health literacy about specific conditions, such as cervical cancer, served as a barrier to both screenings and vaccinations, while a lack of knowledge about the purpose, cost, and availability of services further reduced participation in preventive care. Communities also faced difficulties accessing reliable public health information, compounded by misinformation and limited internet access, further isolating them from critical health resources.
Neighborhood and physical environment One's built environment includes access to nutritious food and diets, crime and violence rates, environmental conditions (air or water pollution), and housing quality. Following numerous studies, the impact of one's environment on their individual health is far greater than originally thought. These studies redefined the environment to include not only traditional environmental exposures, such as pollution, but also elements of the physical environment, such as walkability and access to parks/gyms, as well as the social environment, including crime rates and community support. Many communities without access to nutritious foods find the overall rates of health issues such as high cholesterol, heart disease, and diabetes to be higher.
Social support networks Strong social connections and support systems are vital for maintaining good health. Friends, family, and community networks provide emotional support, practical assistance, and a sense of belonging, which buffer against stress and contribute to mental and physical well-being. Conversely, social isolation and lack of social support are linked to increased mortality rates and poorer health outcomes across various age groups. There are also government support networks, such as Medicare, which are supposed to provide aid to those who are elderly, disabled, or, for any reason, unable to afford care.
Healthcare access and quality Disparities in healthcare access contribute to inequities in health outcomes among different populations. Underdeveloped countries have significantly less access to healthcare, but even in developed countries like the United States, certain areas, such as rural areas, are increasingly having difficulty accessing healthcare due to the lack of hospitals and care centers.