Background

Good quality health care is a determinant of health, and access, affordability, and acceptability of health are all socially and politically determined.  But most of the social determinants of health lie outside the health care system.

These include good quality care and education in early childhood, and education in later childhood and adolescence, as well life-long learning, all of which help create the conditions that enable people to have control over their lives.

Working conditions, and contractual conditions of employment are also key determinants of health, as is having sufficient income for healthy living and living in adequate housing, and living in a built and natural environment that protects from harm and enables healthy living.

The causes of the causes

The social determinants of health, sometimes known as the causes of ill health, are complex, and a number of diagrams have been developed to explain them and how they inter-relate. 

The WHO Commission on Social Determinants of Health developed the diagram below to set out the causes of the causes: the conceptual basis for its work. 
Source: Closing the gap in a generation: Health equity through action on the social determinants of health: Final report of the Commission on Social Determinants of Health (CSDH). Geneva: World Health Organization (WHO); 2008.

Explaining the diagram above

1. Socioeconomic and political context of a country can be understood as  - the the main characteristics of a country that influence the form and magnitude of social stratification as well as the implications of stratification for the conditions in which people are born, grow, live, work and age.
2. Social position identifies key dimensions of social stratification, and raises questions about how extensive stratification is along any of the dimensions in a particular society.
3. The next box lists types of exposures, vulnerabilities and consequences that people experience differently based on their social position, the extent of social stratification and socioeconomic and political context of a country. These include the material conditions in which people are born, grow, live, work, and age, the extent of social cohesion in a society, psychosocial factors, such as sense of control, health related behaviours, and biological factors. The health care system plays a role in ill health prevention, health promotion and treatment of ill health. Combinations of these factors, in particular, the accumulation of positive and negative influences on health from before birth and throughout life, affects health and wellbeing and risk of premature mortality.
4. Finally, inequalities in health and well-being can be identified.  Where health inequalities are considered to be avoidable by reasonable means they are inequitable: taking action to reduce them is a matter of social justice.

Further, the diagram below illustrates the process of how action across the lifecourse accumulates positive and negative effects on health and wellbeing.

Source: Fair Society Healthy Lives (2010)

More about what we do:

• Working Toward Health Equity
• Monitoring and Evaluating Progress
• Promoting What Works
• Building Networks