FAQ for Social Determinants of Health – Flashcards

Social determinants of health are economic and social conditions that influence the health of people and communities [1]. These conditions are shaped by the amount of money, power, and resources that people have, all of which are influenced by policy choices. Social determinants of health affect factors that are related to health outcomes. Factors related to health outcomes include: How a person develops during the first few years of life (early childhood development) How much education a persons obtains Being able to get and keep a job What kind of work a person does Having food or being able to get food (food security) Having access to health services and the quality of those services Housing status How much money a person earns Discrimination and social support

Determinants of health are factors that contribute to a person's current state of health. These factors may be biological, socioeconomic, psychosocial, behavioral, or social in nature. Scientists generally recognize five determinants of health of a population [2, 3]: Genes and biology: for example, sex and age Health behaviors: for example, alcohol use, injection drug use (needles), unprotected sex, and smoking Social environment or social characteristics: for example, discrimination, income, and gender Physical environment or total ecology: for example, where a person lives and crowding conditions Health services or medical care: for example, access to quality health care and having or not having insurance Five major determinants of population health Other factors that could be included are culture, social status, and healthy child development. Figure 1 represents rough estimates of how much each of the five determinants contributes to the health of a population. Scientists do not know the precise contributions of each determinant at this time. As the figure shows, in theory, genes, biology, and health behaviors together account for about 25% of population health. Social determinants of health represent the remaining three categories of social environment, physical environment/total ecology, and health services/medical care. These social determinants of health also interact with and influence individual behaviors as well. More specifically, social determinants of health refer to the set of factors that contribute to the social patterning of health, disease, and illness.

Addressing social determinants of health is a primary approach to achieving health equity. Health equity is "when everyone has the opportunity to 'attain their full health potential' and no one is 'disadvantaged from achieving this potential because of their social position or other socially determined circumstance'" [5]. Health equity has also been defined as "the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages—that is, different positions in a social hierarchy" [6]. Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. The Centers for Disease Control and Prevention (CDC) is committed to achieving improvements in people's lives by reducing health inequities. Health organizations, institutions, and education programs are encouraged to look beyond behavioral factors and address underlying factors related to social determinants of health.

The World Health OrganizationExternal Web Site Icon (WHO) created the Commission on Social Determinants of HealthExternal Web Site Icon to address social determinants of health [1]. The Commission uses the following three principles to guide its work in eliminating health inequities for local communities and nations and throughout the world: Improve the conditions of daily life—the circumstances in which people are born, grow, live, work, and age. Tackle the inequitable distribution of power, money, and resources—the structural drivers of those conditions of daily life—globally, nationally, and locally. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health [1]. The commission created the conceptual framework below that describes relationships among individual and structural variables. The framework represents relationships among variables that are based on scientific studies or substantial evidence. The framework provides a point from which researchers can take action, such as creating targeted interventions, on social determinants of health.

The mission of the National Center for Chronic Disease Prevention and Health Promotion includes a strategic initiative to address health equity through its work in chronic diseases. It accomplishes this by influencing program and policy activities, building partner capacities, and establishing tailored interventions to help eliminate health disparities. Some of the center's activities include (see http://www.cdc.gov/socialdeterminants/FAQ.html)

If your office is interested in developing work related to social determinants of health; the 2008 Consultation Meeting Report Adobe PDF file from NCHHSTP provides examples of opportunities and recommendations, for CDC and others, of future directions regarding social determinants of health in four areas:

1. Public Health Policy 2. Data Systems 3. Agency Partnerships and Capacity Building 4. Prevention research and evaluation.