Author: Jasmyn J. Tang, MPH
January 2, 2025
According to the World Health Organization (WHO),[1] social determinants of health (SDH or SDOH) greatly influence health inequities, with research showing that SDHs can account for up to 55% of health outcomes. These social determinants are complex factors and systems that shape the conditions of daily life. These conditions contribute to the positive or negative effects of health equity and human rights.
Description of SDOHs
Determinants, whether structural (i.e., political, legal, economic), social, or institutional, are shaped by conditions in which people are born, grow, live, work, play, and age.[1] Though the effects of SDHs are clear, implementing changes involves all levels of government and stakeholders. Unfortunately, discrimination is commonly embedded in institutional and system processes, leading to under-represented groups or underserved populations.[2]
SDOH | Goal | Background |
Increase educational opportunities and help children and adolescents do well in school | Populations with higher levels of education are more likely to lead to healthier and longer lives. Children from low-income families, those with disabilities, or those who routinely experience forms of social discrimination are more likely to struggle with math and reading. | |
Increase access to comprehensive, high-quality healthcare services
| 1 in 10 people in the United States don’t have health insurance, making them less likely to have a primary care provider, leading to not getting recommended health care services, like cancer screenings. Other times, lack of access is due to provider distance. | |
Create neighborhoods and environments that promote health and safety.
| Neighborhoods have a major impact on the health and well-being of many families, with many in the United States living in neighborhoods with high rates of violence, unsafe air or water, and other health and safety risks. Racial/ethnic minorities and low-income individuals are also more likely to live in places with these risks. | |
Increase social and community support
| Relationships and interactions with family, friends, co-workers, and community members have a major impact on health and well-being. Many people face challenges and dangers they can’t control, like unsafe neighborhoods, discrimination, or have trouble affording necessities - resulting in negative impacts on health and safety. | |
Help people earn steady incomes that allow them to meet their health needs
| In the United States, 1 in 10 people live in poverty. While those with steady employment are more likely to be healthy, many struggle with finding or keeping jobs or don’t earn enough to afford daily necessities to stay healthy. People with disabilities, injuries, or conditions like arthritis are especially limited in their ability to work. |
CSDH Framework
The Commission on Social Determinants of Health (CSDH), formed by the WHO, expertly conceptualized the impact of SDH mechanisms on equity in health and well-being.[3] This framework dictates that “…social, economic and political mechanisms give rise to a set of socioeconomic positions, whereby populations are stratified according to income, education, occupation, gender, race/ethnicity and other factors…” These in turn can shape specific determinants of health status that are reflective of an individual’s place within social hierarchies. In addition, illness can also reflect and change an individual’s social position by compromising employment opportunities, thus reducing income.
Human Rights
The role of health equity is to promote the right to “the highest attainable standard of health”, as defined by Article 12 of the International Covenant on Economic, Social, and Cultural Rights (ICESCR)[4] This outcome is influenced by SDH conditions that individuals encounter daily. Thus, access to equitable healthcare is also a human right, a fundamental and universal right all people have, regardless of status.[5] These principles undoubtedly have a cause-and-effect relationship. Worldwide, disadvantaged populations continuously experience worsening health.[4] In 2016, non-communicable diseases (NCDs) were the most likely cause of the 15 million premature deaths that occurred in low and middle-income countries. In addition, the under-5 mortality rate is more than eight times higher in African regions than in European regions.[1]
Without ensuring equitable services and infrastructure, well-being will decrease, leading to inequities in access to healthcare, education, and food - basic human rights that impact health. Determinants including poverty, discrimination, and unemployment are overlooked or declining, hindering efforts to the improve human rights and SDHs.[6] Understanding these relationships can facilitate future research to address and improve sustainable conditions free from discrimination and human rights violations.[4,6]
Glossary
Commission on Social Determinants of Health: The WHO Commission on Social Determinants of Health (CSDH) was established to support countries and global health partners to address the social factors leading to ill health and inequities. It drew the attention of society to the social determinants of health that are known to be among the worst causes of poor health and inequalities between and within countries.
Health Equity: The state in which everyone has a fair and just opportunity to attain their highest level of health.
Human Rights: Rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status.
Social Determinants of Health: Conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
World Health Organization: Founded in 1948, WHO is the United Nations agency that connects nations, partners and people to promote health, keep the world safe, and serve the vulnerable. WHO leads global efforts to expand universal health coverage while directing and coordinating the world’s response to health emergencies.
Sources
Social Determinants of Health. World Health Organization. Accessed November 26, 2024. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_2.
Health equity. World Health Organization. Accessed November 26, 2024. https://www.who.int/health-topics/health-equity#tab=tab_3.
A conceptual framework for action on the Social Determinants of Health. World Health Organization. 2010. Accessed November 26, 2024. https://www.who.int/publications/i/item/9789241500852.
Bravemen P. Social Conditions, health equity, and human rights. Health and Human Rights Journal. December 2010. Accessed November 26, 2024. https://www.hhrjournal.org/2013/08/26/social-conditions-health-equity-and-human-rights/.
Human rights. United Nations. 2023. Accessed November 26, 2024. https://www.un.org/en/global-issues/human-rights#:~:text=Human%20rights%20are%20rights%20inherent,freedoms%20of%20individuals%20or%20groups.
Maker Y, McSherry B. Human rights and the social determinants of mental health: Fostering interdisciplinary research collaboration. Psychiatry, Psychology and Law. Published online September 19, 2023:1-14. doi:10.1080/13218719.2023.2243297