What are the Social Determinants of Health?

Find out the different factors that contribute to health inequalities across a population and why they exist.

May 2021
Sana Khan (Blogger)
Aston University - 1st Year Medical Student

What are health inequalities?

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Health inequalities are the differences in health status across different population groups due to social, economic and political factors. One could argue that overall, people are living longer and more healthily now than they did in the past. However, there are many health inequalities that lead to certain population groups having better or worse health outcomes than others.

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What factors affect health?

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According to the Dahlgren and Whitehead rainbow, the determinants of health can be divided into five different categories:

  1. Constitutional factors such as age and sex.
  2. Individual lifestyle factors.
  3. Social and community networks.
  4. Living and working conditions such as unemployment, housing and work environment etc
  5. General socio-economic, cultural and environmental conditions.

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What are the social determinants of health?

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The term 'social determinants of health' is used to describe any non-medical factor that influences health outcomes. The following list has been provided by WHO and identifies various social determinants of health that can contribute to health inequalities.

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Think about each of these, and consider how they relate to someone's health.

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Let's look at an example.

It might be strange for working life conditions to be a factor that affects health, but if we dissect this further we can see how. People who are struggling financially are more likely to work jobs that have long unsocial hours, which will have a knock-on effect on their health. Their work conditions and hours may affect the quality of their sleep, their mental health, their ability to exercise or take an adequate lunch break. They may not be eating enough food or might be relying on cheap takeaways as they may not have enough time to make healthy meals. They may not be able to make a GP appointment if they need it because they are working from 9-5 and can't afford to take time off. As a result, they may be more tired, depressed, and overweight, which may, in turn, increase their risk of developing conditions like diabetes, high blood pressure, or high cholesterol.

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What is the inverse care law?

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The inverse care law states that the availability of good medical care tends to vary inversely with the need of the population served (Tudor Hart, 1971). This means that those with the poorest health who need medical care the most, are the least likely to receive it.

We know that the more deprived someone is, the more they are likely to suffer from health conditions. Let's look at two examples:

  1. In deprived areas where many people have poor health, there tend to be fewer doctors and healthcare professionals.
  1. The rates of immunisations and screening for cervical and breast cancer are considerably lower in deprived areas, even though this is where cancer mortality is at its highest.

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Theories that explain health inequalities

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Many theories have been put forward to try and explain why these health inequalities exist.

These include the following:

  1. Social Causation Theory
  1. ‍Cultural-behavioural Theory
  1. ‍Materialist Theory
  1. ‍Psychosocial Theory
  1. ‍‍‍The Artefact Theory‍

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These theories all try to explain why there are differences in health outcomes in different population groups. Which theory or theories do you agree with the most? Do you think only one is true, or is it a combination? Is there anything that is missing from these explanations?

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Practice Interview Questions

  1. What can be done to reduce health inequality in the UK and around the world?
  2. Do you think the NHS is truly free for all? Who might someone disagree?
  3. Design a breast cancer screening programme for a deprived inner-city area. Consider how you would tell the community, where you would run it, what time you would do it, etc.
  4. Other factors that affect health are age, gender and ethnicity. How do each of these factors impact health?

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Authors: Sana Khan & Latifa Haque

Editor: Latifa Haque

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