ABSTRACT
The objective of this essay is to clarify the understanding and use of Social Determinants of Health by exploring basic characteristics of ‘determinants’ and ‘fundamental causes,’ the ‘social,’ ‘structure,’ and ‘modifiability,’ and to consider theoretical and practical implications of this reconceptualization for public health. The analysis distinguishes SDOH from other determinants of health. Social determinants of health are defined as mutable societal systems, their components, and the social resources and hazards for health that societal systems control and distribute, allocate and withhold, and that, in turn, cause health consequences, including changes in the demographic distributions and trends of health. A systems conceptualization holds concepts such as “race” as the creations of social systems and as having negative consequences, such as racism, when part of a racist system, but potentially ameliorative consequences when part of an anti-racist system. The integration of SDOH into public health theory and practice may substantially expand the benefits of public health, but will require new theorizing, intervention research, education, collaboration, policy, and practice.
REFERENCES
Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol 2001;30:668-77. DOI: https://doi.org/10.1093/ije/30.4.668
Raphael D. Social determinants of health: present status, unanswered questions, and future directions. Int J Health Serv 2006;36:651-77. DOI: https://doi.org/10.2190/3MW4-1EK3-DGRQ-2CRF
Virchow R, Leubuscher R. [Die medicinische Reform: eine Wochenschrift: 1. und 2. Jahrgang: 1848/49].[in German]. Olms; 1975.
Benach J, Vives A, Amable M, et al. Precarious employment: understanding an emerging social determinant of health. Annu Rev Public Health 2014;35:229-53. DOI: https://doi.org/10.1146/annurev-publhealth-032013-182500
Blouin C, Chopra M, van der Hoeven R. Trade and social determinants of health. Lancet 2009;373:502-7. DOI: https://doi.org/10.1016/S0140-6736(08)61777-8
Castañeda H, Holmes SM, Madrigal DS, et al. Immigration as a social determinant of health. Annu Rev Public Health 2015;36:375-92. DOI: https://doi.org/10.1146/annurev-publhealth-032013-182419
Czyzewski K. Colonialism as a broader social determinant of health. Int Indig Policy J 2011;2:5. DOI: https://doi.org/10.18584/iipj.2011.2.1.5
Nolan M, Rikard-Bell G, Mohsin M, Williams M. Food insecurity in three socially disadvantaged localities in Sydney, Australia. Health Promot J Austr 2006;17:247-53. DOI: https://doi.org/10.1071/HE06247
Phillips SP. Defining and measuring gender: a social determinant of health whose time has come. Int J Equity Health 2005;4:1-4. DOI: https://doi.org/10.1186/1475-9276-4-11
Hahn RA, Truman BI, Williams DR. Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM Popul Health 2018;4:17-24. DOI: https://doi.org/10.1016/j.ssmph.2017.10.006
Epstein B. What are social groups? Their metaphysics and how to classify them. Synthese 2019:1-34.
Hahn RA, Schoch-Spana M. Anthropological foundations of public health; the case of COVID 19. Prev Med Rep 2021;22:101331. DOI: https://doi.org/10.1016/j.pmedr.2021.101331
Wallace-Wells D. The uninhabitable earth: Life after warming: Tim Duggan Books; 2020.
Kolbert E. Why call recent disasters ‘natural’ when they really aren’t? National Geographic [Internet]. Available from: nationalgeographic.com/magazine/article/why-call-recent-disasters-natural-when-they-really-are-not
Hahn RA. Two paths to health in all policies: The traditional public health path and the path of social determinants. Am J Public Health 2019;109:253-4. DOI: https://doi.org/10.2105/AJPH.2018.304884
Muennig P, Fiscella K, Tancredi D, Franks P. The relative health burden of selected social and behavioral risk factors in the United States: implications for policy. Am J Public Health 2010;100:1758-64. DOI: https://doi.org/10.2105/AJPH.2009.165019
Abbott A. The system of professions: An essay on the division of expert labor. University of Chicago Press; 2014.
Wilkerson I. Caste (Oprah’s Book Club): The origins of our discontents. New York: Random House; 2020.Susser M, Susser E. Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. Am J Public Health 1996;86:674-7. DOI: https://doi.org/10.2105/AJPH.86.5.674
Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health 2011;32:381-98. DOI: https://doi.org/10.1146/annurev-publhealth-031210-101218
World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health – Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008. Available from: https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1
Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health 2010;100:590-5. DOI: https://doi.org/10.2105/AJPH.2009.185652
Food and Drug Administration, HHS. Final determination regarding partially hydrogenated oils. Notification; declaratory order; extension of compliance date. Fed Regist 2018;83:23358-9.
Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol 2015;41:311-30. DOI: https://doi.org/10.1146/annurev-soc-073014-112305
Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep 2014;129:S19-31. DOI: https://doi.org/10.1177/00333549141291S206
Alderwick H, Gottlieb LM. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Milbank Q 2019;97:407-19. DOI: https://doi.org/10.1111/1468-0009.12390
Krieger N. A glossary for social epidemiology. J Epidemiol Commun Health 2001;55:693-700. DOI: https://doi.org/10.1136/jech.55.10.693
Link BG, Phelan JC. Social conditions as fundamental causes of disease. J Health Soc Behav 1995;Spec No:80-94. DOI: https://doi.org/10.2307/2626958
Services USDoHaH. Healthy People 2030. Washington, DC: U.S. Department of Health and Human Services; 2020.
Epstein B. Social ontology. Stanford Encyclopedia of Philosophy; 2018.
World Health Organization. A conceptual framework for action on the social determinants of health. Geneva: World Health Organization; 2010. Available from: https://apps.who.int/iris/handle/10665/44489
Rothman KJ. Modern epidemiology. Boston: Little Brown; 1986.
Rothman KJ, Stein Z, Susser M. Rebuilding bridges: what is the real role of social class in disease occurrence? Eur J Epidemiol 2011;26:431. DOI: https://doi.org/10.1007/s10654-011-9579-0
Braveman P, Krieger N, Lynch J. Health inequalities and social inequalities in health. Bull World Health Organ 2000;78:232-5.
Katz MH. Structural interventions for addressing chronic health problems. JAMA 2009;302:683-5. DOI: https://doi.org/10.1001/jama.2009.1147