Social Determinants of Health (SDoH)

In 2003, the World Health Organization identified 10 social determinants that impact on the capacity of individuals and communities to make healthy choices: the social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food and transport (Wilkinson and Marmot 2003). These determinants have developed over time, and when operationalised at the national level are often expanded or contracted to suit local contexts. Mostly, when expanded, these lists include individual-level attributes such as indigeneity, race, gender and disability (see e.g. Canadian Public Health Association 2016). While some social determinants are more important to health than public safety (e.g. access to food), the terminology and definitions used in both align at policy and practice levels.

Importantly, since the creation of the Commission on Social Determinants of Health in 2008, the World Health Organization has framed the social determinants in more generalist and universal language, such that it now prioritises the processes for addressing the determinants rather than the attributes that constitute the determinants. In the Rio Political Declaration (2011), member states endorsed an action plan to address the SDoH by:

  • • improving health governance
  • • promoting participation in policy development and implementation
  • • orienting health services to health promotion and reducing health inequalities
  • • strengthening global governance and cooperation, and
  • • increasing accountability through monitoring and evaluation.

In the wake of the Rio Political Declaration (2011), the WHO defines the SDoH as ‘the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels’ (World Health Organization 2016a). Arguably, this revision makes it more difficult to operationalise and measure changes in the SDoH. However, at the same time as the definition is widened to see causal relationships between all aspects of human life and health, the quantification of health and health inequalities, the collection of big data and the instruments used to measure changes over time and place have become more sophisticated, and form the basis of an evidence-based approach (Kelly et al. 2007; Penman-Aguilar et al. 2016).

 
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