Social Determinants of Health

Public health has studied the relationship of morbidity and mortality to the living conditions of populations, with a greater focus on the individual level. In this context, an important theoretical advance was made in social determinants of health approaches (SDH), providing a way of explaining multiple socioeconomic conditions that determine ways of living, of falling ill and of dying in specific populations. Despite advances in terms of its theoretical foundations, the methodological development of SDH approaches presents important lags in the metrics used, by: 1) erroneously functionalizing certain social constructs, 2) applying designs with risks of incurring fallacies (ecological, atomistic, sociological or psychological), or 3) applying designs that do not relate individual, particular and general measurements in a multilevel structure. Within this framework, this manuscript answers the question: what are the methodological challenges in the incorporation of metrics to SDH research, considering the need to articulate different levels of reality? In order to achieve this, it develops the following components: contextualization of SDH approaches, including the philosophical divergences and methodological convergences of its approaches, and the theoretical-conceptual foundations of ecological studies and multilevel analyses.

The article discusses the use of data and socioeconomic factors and social determinants of health (SDOH) in order to determine the root causes of alleged racial disparities in COVID-19 health outcomes. The author discusses systemic racism, federalism in the U.S., and the 2020 U.S. presidential campaign and subsequent election of candidate Joe Biden.

This Editorial provides a critical review of the progress in social determinants of health research over the last two decades, suggesting new perspectives which may further our understanding of persistent social inequalities in health. It highlights the global significance of the Special Issue setting it in the context of the recently released WHO Commission on Social Determinants of Health Final Report (CSDH 2008). The Editorial introduces individual papers in the Special Issue and discusses how they are in line with, complement or provide feedback to, the WHO CSDH Final Report and its call for actions to close the health gap in a generation. Finally, based on the articles in this Special Issue and emerging themes of the global research and policy literature, it outlines a number of significant directions for future research and actions, from both methodological and theoretical points of view.

This study argues that, despite commitments by Australia, Canada and New Zealand to improving outcomes for Indigenous peoples, the social, economic and health disparities between Indigenous and non-Indigenous peoples in these countries have seen no significant decrease between 1981 and 2006. The authors analyze and compare census data from the three countries for every 5-year period (starting in 1981 and ending in 2006) to measure disparities in three key social determinants of health between Indigenous and non-Indigenous people between 25 and 29 years old: education, employment and income. While the proportion of Indigenous people with a Bachelor’s degree or higher grew over this period, the gap between Indigenous and non-Indigenous people with a Bachelor’s degree or higher increased. Indigenous people had consistently higher unemployment over this period, with the gap between Indigenous and non-Indigenous unemployment narrowing in both Australia and Canada, but widening slightly in New Zealand. Despite a decreased gap in employment in Australia, that country maintained the widest unemployment gap between Indigenous and non-Indigenous people. Gaps in median income narrowed in Canada and New Zealand over the time period, while the gap remained steady in Australia, with Indigenous Australians making just over half of the median annual income made by non-Indigenous Australians. The authors conclude that existing approaches to addressing inequity for Indigenous people in these wealthy countries are proving ineffective, and that new approaches must be developed to improve socioeconomic outcomes for Indigenous people.

This study demonstrates the causal impact of a poverty reduction intervention on early childhood brain activity. Data from the Baby’s First Years study, a randomized control trial, show that a predictable, monthly unconditional cash transfer given to low-income families may have a causal impact on infant brain activity. In the context of greater economic resources, children’s experiences changed, and their brain activity adapted to those experiences. The resultant brain activity patterns have been shown to be associated with the development of subsequent cognitive skills.

Recovery is a policy framework for mental health in Canada. Key challenges to the integration of recovery include a gap in knowledge about the work that people do to promote their health and well-being in the context of living with mental ill health. This study used Photovoice to explore the lived realities of people living with mental ill health and the impact of the social determinants on their recovery process. Findings from this study inform policy and practice on promoting health work as an important dimension of recovery and community inclusion.

Objective: To identify and describe caregiver perspectives on factors important for the health and wellbeing of urban Aboriginal children. Methods: Caregivers of Aboriginal children participating in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) were asked to describe the single most important factor that would help their children to be healthy and well. Responses were analysed using thematic and content analysis. Results: Of the 626 carers in SEARCH, 425 (68%) provided a response. We identified 13 factors related to: loving family relationships, culturally competent healthcare, food security, active living, community services, education, social and emotional connectedness, safety, breaking cycles of disadvantage, housing availability and affordability, positive Aboriginal role models, strong culture, and carer wellbeing. Conclusions: Aligning with holistic concepts of health, caregivers believe that a broad range of child, family and environmental‐level factors are needed to ensure the health and wellbeing of Aboriginal children. Implications for public health: This study highlights the importance of providing public health initiatives that enable equal access to the social determinants of health for carers of Aboriginal children. Affordable and adequate housing, food security, culturally appropriate healthcare, and family and community connectedness remain critical areas for targeted initiatives.

The authors discuss the social and structural determinants of youth violence in the U.S. They mention the impact of violence on Black youth, the social and structural problems that Black youth face that contribute to violence, and the opportunities for youth to contribute to the prevention of violence in their communities.

Social determinants of health reflect the circumstances, conditions, and contexts of peoples’ lives, and the effect these have on health and wellbeing. Indigenous peoples are consistently ranked lower in almost every determinant of health, resulting in profound health impacts and inequities. Social determinants of health in an Indigenous context include unique structural determinants such as the continuing impact of colonialism. Addressing Indigenous health inequities requires focusing on changing underlying structural determinants rather than just addressing symptomatic effects, and needs to be done using a strength-based perspective that celebrates positive determinants such as connection to the land, relationships and communities.

The health of Canada's children when placed in comparative perspective with other wealthy developed nations is mediocre at best. Much of this has to do with the social determinants of children's health (SDCH) in Canada being of generally lower quality and more inequitably distributed than is the case in most other wealthy developed nations. The SDCH are of two kinds: (a) those to which their parents are exposed, and (b) those specifically related to societal support for early child development. In both cases Canada's support of the SDCH through the making of health promoting public policy is lacking. Much of this has to do with the political ideology of ruling governments consistent with Canada being identified as a liberal welfare state where intervention in the unbridled operation of the market system is frowned upon. There are means of improving the situation. These involve a wide range of activities from more responsive clinical practice through to advocacy and political action.

Child maltreatment is a highly prevalent public health concern that contributes to morbidity and mortality in childhood and short- and long-term health consequences that persist into adulthood. Past research suggests that social determinants of health such as socioeconomic status and intergenerational trauma are highly correlated with child maltreatment. With support from the U.S. Children’s Bureau, the Ohio Children’s Trust Fund is currently piloting the Family Success Network, a primary child maltreatment prevention strategy in Northeast Ohio that seeks to address these social determinants through pillars of service that include family coaching, financial assistance, financial education, parenting education, and basic life skills training. This study highlights the initial development phase of a pilot study. Plans for in-depth process and outcome evaluations are discussed. The project seeks to improve family functioning and reduce child protective services involvement and foster care entry in an economically disadvantaged region.

These Canadian Best Practices Portal resources provide Canadian and international information to help you plan approaches to address the social determinants of health, including data, government strategies, guidance, and systematic reviews.

The purpose of this study was to investigate how an individual’s social determinants of health are affected by the acquisition of physical disability in adulthood.