Social determinants of health have come to greater prominence through the recent work of the WHO Commission on the Social Determinants of Health, and the Marmot Review of Health Inequalities in England. These reports also have significant implications for promotion of mental health in developed countries. In particular they reflect a growing research interest in the view that certain adverse social conditions may detrimentally affect mental or physical health by acting as chronic stressors. However, although the case for chronic arousal of stress systems as a risk factor for mental health is empirically well-founded, questions remain about how and why psychological exposure to certain kinds of proximal social conditions might contribute to such arousal.In this paper we argue that combining evidence and ideas from a number of disciplines, including public health research and psychiatry, presents an opportunity to understand the relationship better, and so inform complementary strategies in treatment, prevention and health promotion.Key words: social determinants, mental health, social environment, preventative health services
Recent perspectives on social determinants of healthThe World Health Organization (WHO) Commission on the Social Determinants of Health (CSDH) recently released its final report [1] calling for action to address social Archived at Flinders University: dspace.flinders.edu.au 3 and economic conditions implicated in major health inequalities both between countries and within individual countries. The report calls for action in areas such as child development, housing, employment conditions, health services, and global trade policy reform. Many of these proposals are concerned with effects of adverse living conditions on physical health. However, the incidence of mental health problems also feature prominently in the report, and is recognised by WHO as a major factor shaping the overall burden of disease in both developed and developing countries [1,2].Public health research on social determinants of health (SDH) within a particular society investigates and compares patterns of health status within and between subpopulations defined according to characteristics such as socioeconomic status assessed by level of income or education (SES), living or working conditions, gender or ethnicity [3]. Similar research looks at differences of health status between whole countries [2,4], however here we will focus on the first form of research, especially as it relates to mental health.Research on SDH in developed countries like Australia has repeatedly demonstrated a similar pattern in certain physical and mental health outcomes across the SES spectrum. Typically, the prevalence of many common, non-communicable conditions including heart disease, diabetes, obesity and major depression tends to increase on a gradient as one goes 'down' the SES spectrum, and is highest in the 'lowest' status groups [5,6]. Where this occurs (in relation to one or several such conditions) it is referred to as a social gradient...