Social determinants of health

Social determinants of health – broadly defined as the conditions in which people are born, grow, live, work and age, and people’s access to power, money and resources – have a powerful influence on health inequities. These are the unfair and avoidable differences in health status seen within and between countries.

At all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. People who have limited access to quality housing, education, social protection and job opportunities have a higher risk of illness and death. Research shows that these social determinants can outweigh genetic influences or healthcare access in terms of influencing health.

Addressing the social determinants of health equity is fundamental for improving health and reducing longstanding inequities in health. It requires action by all parts of government, the private sector and civil society. WHO is committed to supporting countries in developing and implementing key policies that address the social determinants of health to reduce health inequities. 

There are challenges to overcome in implementing action to address health inequities through the social determinants of health. The social determinants of health equity is a complex and multifaceted field. It involves a wide range of stakeholders within and beyond the health sector and all levels of government. In addition, social determinants of health data can be difficult to collect and share.

While the evidence base on the social determinants of health has strengthened during the past decade, the evidence base on what works needs to be strengthened and good practices disseminated effectively.

Three areas for critical action identified in the report of the Global Commission on Social Determinants of Health reflect their importance in tackling inequities in health. These include:

• Improve daily living conditions:

  The circumstances in which people are born, grow, live, work and age;
  

• Tackle the inequitable distribution of power, money and resources:

  The structural drivers of those conditions of daily life (for example, macroeconomic and urbanization policies and governance); 

• Measure and understand the problem and assess the impact of action:

  Expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.

  Scaled up and systematic action is required that is universal but proportionate to the disadvantage across the social gradient. This is necessary for effective delivery to addressing inequities in health and promoting healthier populations.

Life expectancy and healthy life expectancy have increased, but unequally. There remain persistent and widening gaps between those with the best and worst health and well-being.

Poorer populations systematically experience worse health than richer populations. For example:

• There is a difference of 18 years of life expectancy between high- and low- income countries;
• In 2016, the majority of the 15 million premature deaths due to non-communicable diseases (NCDs) occurred in low- and middle-income countries;
• Relative gaps within countries between poorer and richer subgroups for diseases like cancer have increased in all regions across the world;
• The under-5 mortality rate is more than eight times higher in Africa than the European region. Within countries, improvements in child health between poorest and richest subgroups have been impaired by slower improvements for poorer subgroups.

Such trends within and between countries are unfair, unjust and avoidable. Many of these health differences are caused by the decision-making processes, policies, social norms and structures which exist at all levels in society.

Inequities in health are socially determined, preventing poorer populations from moving up in society and making the most of their potential.

Pursuing health equity means striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditions.

Action requires not only equitable access to healthcare but also means working outside the healthcare system to address broader social well-being and development.

“Health equity is defined as the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically”.