Social determinants of health-ourselves and globally
WHO defines the social determinants of health:
“The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”
which itself is shaped by policy choices.3 Social determinants of health are the main cause of health disparities within and between countries. It is viewed as the unfair and avoidable differences in health status within and between countries.3 The social determinants of health on one hand includes accessibility to clean water and sanitation, food security, gender equality, economic and social security, and access to appropriate healthcare resources.3 On the other hand, international sanctions which lead to unhealthy living environments, war effects which results in refugees and internally displaced people, and poverty which includes labour and employment conditions and the distribution of resources within and among antions.3
Health is part of wellbeing, of how people feel and function and contributed by social and economic wellbeing. There are various determinants which contribute to health such as social, cultural, socioeconomic, environmental, behavioural and genetic factors.1
The inequitable distribution of money, power and resources will play a significant role in affecting health. The upstream (macro-level) factors of health include social determinants of health such as government, resources, culture and socioeconomic.2
Global health emphasises the improvement on health and achieve equity of health for all people worldwide. Moreover, global health focuses on geographical reach which transcend national boundaries and allows global cooperation for developing and implementing health solutions and promotes population-based prevention with clinical care of individuals. Global factors can directly affect government policies.
Upstream factors (macro-level) such as government policies, global forces and cultural factors affect economic, welfare, health, housing transport and taxation of the country. Environmental factors such as geographical location, remoteness, natural or built will also affect the socioeconomic factors.2 Socioeconomic factors are affected by government policies and contribute to local economy, markets, wealth and education opportunities.2 Socioeconomic factors also include housing, migration status, food security and access to services. Education creates employment opportunities and occupations generate income and wealth of individuals.
These political, environmental and socioeconomic factors will affect midstream (intermediate-level) factors of health such as psychological factors which contribute to health behaviours.1 Psychological factors include stress, depression, anxiety and expectations which induce poor health behaviours such as the use of tobacco, illicit drugs and alcohol.1
These psychological factors also affect health behaviours of individuals. Health behaviours include diet/nutrition, smoking, alcohol, physical activity, self-harm/addictive behaviours and preventative health care use. Accessibility, availability, affordability and utilisation of health care system is one of the midstream factors which affect the downstream factors.
Midstream factors directly affect downstream factors (micro-level) such as physiological, biological and health of individuals in a country or population. Physiological systems include endocrine and immune, which affects biological reactions such as glucose intolerance, body mass index, hypertension, fibrin production, adrenalin, suppressed immune response and blood lipid levels.1 Health outcomes of a population include life expectancy, morbidity and mortality.2
Individual physical and psychological makeup such as genetics, antenatal environment, gender, ageing, life course and inter-generational influences affect all levels of factors of health (from upstream to downstream factors).
Global interaction, communication and cooperation across nations and countries are global factors which contribute to the inequitable distribution of money, resources and power. Political structures, culture, affluence, social cohesion, social inclusion, media and language are community-level factors which contribute to health disparities due to inequitable distribution of money, resources and power. Individuals’ income, wealth, education and employment contribute to inequitable distribution of money, power and resources. Moreover, individuals’ health behaviours such as smoking and individuals’ psychological factors such as trauma and stress contribute to health disparities.
An inequitable distribution of money, resources and power in a country will definitely affect the state of health in the country and contribute to health inequalities of the people such as midstream (psychological and health behaviours) and downstream (health wellbeing) factors.1 Power represents government policies and culture, whereas money and resources refer to education, income level and job opportunities and healthcare access.2
People with higher income and social status generally have better health than people with lower income and social status.4 The greater the gap between the richest and the poorest people, the greater the differences in health.4 People with low education levels have poor health, more stress and lower self-confidence compared to people with higher education levels.4 Equal distribution and access of health services which prevent and treat diseases lead to better health. Social support network such as greater support from families, friends and communities provide better health outcomes. Culture, customs and traditions and the beliefs of the family and community affect health.4 Physical environment where there are equal distribution of safe water and clean air, health workplaces, safe houses, communities and roads all contribute to healthier lives. People in employment are generally healthier in particular to those who have control over their working conditions.4
1. National Centre for Epidemiology and Population Health (AU). Health equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol and tobacco [Internet]. National Centre for Epidemiology and Population Health (AU); 2009 [cited 2014 Mar 10]. Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/0FBE203C1C547A82CA257529000231BF/$File/commpaper-hlth-equity-friel.pdf
2. U.S Department of Health and Human Services (USA). Social determinants of health [Internet]. U.S Department of Health and Human Services (USA); 2013 [updated 2013 Nov 13; cited 2014 Mar 10]. Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
3. Hixon, AL, Yamada S, Farmer, PE & Maskarinec GG. Social justice: The heart of medical education. Social Medicine [Internet]; 2013 [cited 2014 Apr 9];7(3):161-168. Available from: http://www.socialmedicine.info/index.php/socialmedicine/article/…/671/1380
4. World Health Organisation. Social determinants of health [Internet]. World Health Organisation [cited 2014 Apr 9]. Available from: http://www.who.int/hia/evidence/doh/en/