The Social Determinants of Health: It's Time to Consider the Causes of the Causes

Abstract

During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)-the factors apart from medical care that can be influenced by social policies and shape health in powerful ways . We use "medical care" rather than "health care" to refer to clinical services, to avoid potential confusion between "health" and "health care ." The World Health Organization's Commission on the Social Determinants of Health has defined SDH as "the conditions in which people are born, grow, live, work and age" and "the fundamental drivers of these conditions ." The term "social determinants" often evokes factors such as health-related features of neighborhoods (e .g ., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors . Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes . This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social-and particularly socioeconomicfactors in shaping health, and plausible pathways and biological mechanisms that may explain their effects . We also discuss challenges to advancing this knowledge and how they might be overcome .

Barriers to outdoor physical activity and unmet physical activity need in older adults

“…The idea of disparities in physical activity is adopted from the concept of health disparities, which are a worldwide phenomenon and have been under vigorous research for decades (Braveman & Gottlieb 2014, Marmot & Bell 2012. It is widely acknowledged that people with different backgrounds can show large differences in several health outcomes as well as in access to health care.…”

“…It is widely acknowledged that people with different backgrounds can show large differences in several health outcomes as well as in access to health care. Further, there is an ethical dimension in the existence of these differences: everyone should have equal possibilities to adequate nutrition, physical activity, housing and access to health care (Braveman & Gottlieb 2014). Social determinants of health, i.e.…”

Evaluating the Accountable Health Communities Demonstration Project

“…The pathway involves many mediating steps, each of which takes time to achieve, along with potential unmeasured confounders. Previous research into the mechanisms linking health and social factors suggests that a 5-year funding window is too short to see many of the end outcomes of interest reflected in claims and utilization data 16 and may result in false-negative findings.…”

“…16 Some social determinants are directly tied to health outcomes, such as the detrimental effect of poor housing conditions on asthma. The impact of ameliorating those factors should be detectable using indicators such as health care utilization and missed workdays.…”

Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians

“…[1][2][3][4][5][6] The influence of such inequities on health has long been noted by clinicians and public health practitioners, but such content has been incorporated unevenly into medical education and clinical training. [7][8][9][10][11][12][13][14][15][16] Proposed by clinicians and scholars in the medical social sciences, a Bstructural competency^framework calls for a Bshift in medical education…toward attention to forces that influence health outcomes at levels above individual interactions.^1 7(p. 126-27) BStructures^or Bsocial structures^in this sense indicate the policies, economic systems, and other institutions (policing and judicial systems, schools, etc.)…”