“When we try to pick out anything by itself, we find that it is hitched to everything else in the universe”, you can probably extrapolate this John Muir quote to health. For far too long, health has been a very specific, very individual-driven personal attribute. Although social inequalities and inequities are not new to any of us, we now have data that show how health is impacted by not just individual preferences/behaviors and biology but also by social, environmental and economic conditions that individuals live in. These are collectively known as social determinants of health (SDH or SDoH) and the WHO defines SDH as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”
Recognizing the impact of social determinants on health, Dr. Frieden introduced the Health Impact Pyramid in 2010.
Source: Health Impact Pyramid
What exactly are social determinants of health? Below is an easy-to-read table from a Policy Brief from Kaiser Family Foundation.
Health equity can be achieved by addressing the upstream root causes a.k.a the social, environmental and economic factors that negatively impact health. Health Equity, as so aptly described in the image below, is defined by the WHO as “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.”
Source: “Interaction Institute for Social Change | Artist: Angus Maguire.”
While there is plenty of evidence for how social determinants impact health, there have not been many solutions that have been tested and you can probably imagine why!
In the coming months, we will explore evidence for working upstream and programs and practices that are being tested to impact health by addressing social determinants of health. If you know of any implementation examples, please leave a comment.