Structural and social determinants of health are non-medical factors that influence health outcomes and are shaped by the broader economic, cultural, political, and social systems within which people live. Structural determinants are the “root causes” like government policies and social norms that establish power and resources, creating predictable health inequities. Social determinants are the resulting conditions of daily life, such as access to quality housing, education, and healthy food, that people are born into and live with, influencing their health over their lifespan. Together, these determinants explain why health disparities exist, as they shape the quality and equity of the environments and experiences necessary for a healthy life.
These are the “upstream” or “root causes” that establish the framework for health outcomes.
-
Governance, Policies, and Systems:
Economic policies, social policies, and political systems that create and maintain social stratifications.
-
Power and Inequality:
The distribution of power, resources, and opportunities based on factors like race, gender, social class, and geography.
-
Societal Norms and Values:
Underlying cultural beliefs, values, and social norms that reinforce hierarchical patterns and disadvantage certain groups.
-
Examples:
Laws, policies, and budget decisions that affect access to necessary resources; the legacy of systemic racism and colonialism.
These are the “intermediate” or “downstream” factors that result from structural determinants.
-
Living and Working Conditions:
Environments and circumstances people are born, grow, live, work, and age in.
-
Examples:
- Neighborhood and Physical Environment: Housing quality, safety, air and water pollution, access to healthy food.
- Economic Stability: Income, employment, financial hardship, and financial stability.
- Education: Access to quality education and educational attainment.
- Healthcare Access and Quality: Access to affordable and quality health care services.
- Social and Community Context: Social support, community cohesion, and experiences with discrimination.
- Neighborhood and Physical Environment: Housing quality, safety, air and water pollution, access to healthy food.
-
Disparate Resource Distribution:
Structural factors determine how resources necessary for health are distributed unequally across society.
-
Vicious Cycle:
Poor social determinants (like unstable housing) can stem from negative structural factors (like economic policies), and these conditions then increase the risk for chronic illness and premature death.
-
Systemic Inequities:
Health inequities are not random; they are predictable outcomes of systems and policies that create social advantages for some groups and disadvantages for others.
About the Author
