Social determinants of health for healthcare providers

Social determinants of health are the circumstances in the environments in which people are born, grow up, live, learn, work and age. 

These include:

• housing, transportation and neighbourhoods
• racism, discrimination and violence
• education, job opportunities and income
• access to nutritious foods and physical activity opportunities
• polluted air and water
• language and literacy skills. 

Social determinants of health are also the wider set of forces and systems affecting these circumstances, eg, economic and development policies, geographic and climatic environments, social norms, social policies and political systems.

All these factors can affect health, wellbeing and quality of life. 

Health inequities are not about ‘making bad choices’, ‘bad genes’ or not accessing medical care. Health inequities usually stem from avoidable structural problems in communities. These social determinants of health can cause health inequities and disparities.

For example, if people don't have access to grocery stores with healthy foods, they are less likely to have good nutrition. This can increase their risk of medical conditions such as heart disease, diabetes and obesity. 

The local economy has an impact on employment opportunities, which then affects income and the quality of housing and food choices. These can then affect the health and wellbeing of a whole family. 

Health promotion or promoting healthy choices won't eliminate these barriers. Instead, all government sectors, such as transportation, education and housing, need to work together to create fair and just policies or systems in order for the public to achieve equivalent outcomes. 

Different inputs for different groups may be required in order to achieve equivalent outcomes.

Video: What Makes Us Healthy? Understanding the Social Determinants of Health

The following video outlines the concept of social determinants of health.

(Let's Learn Public Health, US, 2017)

Health inequalities or health inequities are avoidable, unnecessary and unjust differences in the health of groups of people. Reducing health inequalities is greatly assisted by tools that enable the assessment of interventions such as policies, programmes and services.

Such tools examine the potential of these interventions to contribute to reducing health inequalities. From such an assessment, informed decisions can be made about how to build and strengthen policies, programmes and services.

In New Zealand, the Health Equity Assessment Tool(external link) has been developed by the Ministry of Health to reduce health inequalities by helping users to improve the ability of mainstream health policies, programmes and services to promote health equity.

It has a set of 10 questions and is designed for use by health sectors throughout the policy, programme and service planning process.

It may also be used by:

• non-governmental organisations, such as the National Heart Foundation
• community groups, to assess the health equity of proposed or current initiatives and inform their input to government agencies
• targeted services, in arguing for the continuation or extension of their services or in considering addressing inequalities within the communities they work with
• other sectors with a significant impact on health, wellbeing and equity, such as housing, welfare and education
• local government, to assist with meeting statutory obligations under the Local Government Act 2002 to promote community social, cultural, economic and
  environmental wellbeing.

Read more about the Health Equity Assessment Tool(external link). 

Determinants of health & health equity(external link) Toi Te Ora Public Health, NZ 
Health Equity Assessment Tool(external link) Ministry of Health, NZ 
Social determinants of health – know what affects health(external link) Centers for Disease Control and Prevention, US
Social determinants of health(external link) Office of Disease Prevention and Health Promotion, US
Health Equity Assessment Tool user's guide(external link)Ministry of Health, NZ, 2008