Social determinants of health are an individual’s personal circumstances that impact their health and well-being. They include political, socioeconomic, and cultural factors, alongside how easily someone can access healthcare, education, a safe place to live, and nutritious food.

The World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

Social determinants of health are an extensive range of factors that exist throughout all aspects of society. However, they are separate from medical care or a person’s individual lifestyle choices.

A study cited by the National Academy of Medicine found that medical care itself only accounted for 10–20% of the contributors to people’s health outcomes.

By contrast, the many social determinants of health play a much bigger role in influencing a person’s health, making up 80–90% of the contributing factors.

This article explores social determinants of health, including their forms and the roles they play in shaping healthcare outcomes.

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Social determinants of health fall into five broad groups:

  • Healthcare: This group encompasses a person’s access to healthcare and its quality. Factors include:
    • access to primary healthcare
    • health insurance coverage
    • health literacy
  • Economic stability: This refers to the link between a person’s finances and their health. Examples of factors are:
    • poverty
    • employment
    • food security
    • housing stability
  • Education: This category focuses on the connection between a person’s access to education and its quality, and their health. Examples include:
    • secondary education
    • higher education
    • language and literacy
    • childhood development
  • Social and community life: This group revolves around the ways a person lives, works, plays, and learns and how these relate to the person’s health. Factors include:
    • civic participation
    • discrimination
    • incarceration
    • conditions within a workplace
  • Neighborhood: This group considers a person’s housing and environment and the role they play in the person’s health. Factors include:
    • quality of housing
    • transportation
    • access to healthy foods
    • water quality
    • crime and violence

The factors in each group are interwoven and often related to each other.

Around 1 in 10 people in the United States are living without health insurance. This means they may not have a primary healthcare professional. They may also not have the money to make vital purchases for their health, such as medications or tests.

Additionally, people may live too far away from a healthcare clinic to get the quality of care they deserve.

Black Americans are more likely to be uninsured than white Americans. In 2018, 9.7% of Black Americans did not have health insurance. Among white Americans, this rate was 5.4%.

Improving quality healthcare access

There are many ways to help improve public access to quality healthcare. For example, clinics could offer remote appointments where possible.

The Healthy People 2030 campaign has several objectives in place to improve healthcare access. For example, it aims to:

  • reduce the wait time in emergency departments
  • increase the proportion of adults who receive lung cancer screenings
  • increase community services that can provide health screenings

Learn more about health equity here.

Economic stability is vital to affording lifestyle choices and paying for quality medical care that keeps people healthy.

A well-paying, steady job is critical for food security and housing stability. Savings are essential for managing chronic conditions or emergencies.

However, 1 in 10 people in the U.S. live in poverty.

Those in steady work may not earn enough to gain access to good quality healthcare. Moreover, chronic conditions or disabilities may put people at an even greater disadvantage.

Many studies have shown wide gaps in health outcomes between countries and communities that have different social determinants of health. People living in high income countries have a life expectancy that is 19 years higher than that of people living in low income countries.

Improving economic stability

The Healthy People 2030 campaign is organizing programs to increase funding for many institutions, including:

  • employment programs
  • career counseling
  • high quality child care

Establishing certain policies can help people pay for their:

  • food
  • housing
  • healthcare
  • education

Learn more about health insurance here.

Data from the U.S. and Europe show a strong association between health indicators and an individual’s income and education level.

Whether a child or adolescent can access quality education throughout their development can determine their future living conditions.

Early childhood education is essential for social and mental development, and good quality high school education can open new doors to further education and employment opportunities.

Children that come from low income households, have disabilities, or experience social discrimination at an early age may be less likely to do well in school. They also face barriers to higher levels of education.

As a result, people from low income households often struggle to get safe, well-paying jobs. It also means they are more likely to experience health conditions such as heart disease, diabetes, or depression.

The stress of having economic difficulties can also adversely impact a person’s health and well-being. For example, living in poverty can negatively affect a child’s brain development.

Improving access to education

The funding of Title I schools in the U.S. has encouraged continued education among those living in low income communities.

The Health People 2030 campaign has several programs in place to improve the proportion of people who have access to high quality education across all age groups.

Interactions between individuals and their family members and co-workers can affect their health.

For example, workplace conditions and discrimination can have an impact on peoples’ moods and self-esteem.

Moreover, high incarceration rates, absent parents, and bullying can all affect a child’s development and feelings of loneliness. This negative effect on a child’s health can continue into their adulthood.

Learn about the effects of racism on mental health here.

Improving community environment

Many social determinants of health are factors that people cannot control individually. Fostering positive relationships at home, at work, or in a person’s community can improve public well-being.

Programs that can better people’s social determinants of health include the social campaigns on the implementation of smoke-free zones that curbed tobacco use and decreased smoking-related disease.

The Healthy People 2030 campaign aims to help people get the social support and care they might need.

For example, it is working to reduce anxiety and depression by providing more support to children and those caring for people with disabilities, among other groups.

A person’s neighborhood and living conditions can directly impact their health and safety.

Many individuals worldwide live in areas with:

  • elevated rates of violent crime
  • high levels of environmental pollutants
  • unsafe air and drinking water

Marginalized racial and ethnic groups, as well as people from low income households, are more likely to live in places that carry these risks.

Even at work, people can come into contact with things that could harm their health, such as secondhand smoke.

Improving living conditions

At local, state, and national levels, people can make changes to improve public environments and overall health.

For example, company owners can reduce health and safety risks at work, and local councils can establish pedestrian or cycle paths.

Learn about how air pollutants affect health here.

The effects of the social determinants of health are more pronounced during crises, as seen in the ongoing COVID-19 pandemic.

A 2021 study found that racial background and socioeconomic status affected COVID-19 incidence and mortality. Marginalized groups are more likely to experience discrimination, crowded living conditions, reliance on public transport, and financial insecurity.

These issues can lead to significant differences in health outcomes during a pandemic.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

The conditions into which people are born and in which they live their lives have a profound effect on their health.

Where a person is born, lives, goes to school, and works is what experts refer to as social determinants of health. These factors influence the opportunities a person has to eat a nutritious diet, have a good education, live and work in a toxin-free environment, access healthcare, and more.

The WHO and governmental bodies continually work toward improving the social determinants of health for all citizens to allow equal access to essential healthcare.