Social Determinants of Health

Amy BurdetteAssociate Professor

Department of Sociology and Public Health ProgramFlorida State University

Introductiono It is now widely accepted that chronic

conditions like heart disease and cancer have multiple causes, and not all of them are biological in origin.

o Today, health professionals and health scholars recognize that social and psychological and biological and behavioral factors influence the onset of sickness, as well as the form, duration, and intensity of symptoms.

Introductiono Social epidemiology is the branch

of epidemiology that studies the social distribution of health, morbidity, and mortality risk.

o The social distribution is defined by social status and social conditions.

IntroductionSocial status indicates one’s

social position:• Age• Gender• Race and Ethnicity• Socioeconomic Status (SES)• Marital Status• Religion

Introductiono Social conditions refer to socially

patterned contexts, circumstances, and environments.

o Social conditions influence health by placing populations at “risk of risks,” increasing vulnerability or susceptibility to poor health, morbidity, and mortality.• Substandard Housing• Neighborhood Disadvantage

Introductiono Social conditions are more or less

stressful or dangerous.

o Social conditions regulate health-relevant behaviors and access to health-relevant institutions and services.

Introductiono Social conditions are environments,

norms, and patterns of social control that are health-promoting or health-damaging.

o Social conditions influence the development of psychosocial resources, which help to protect against ill-health, morbidity, and mortality.

Introductiono Central questions:

1. How do social statuses and social conditions shape health patterns and mortality risk?

2. Why do social statuses and social conditions shape health patterns and mortality risk?

Introduction

Social Status Health

Sociological Public HealthSocial SocialEpidemiologists Epidemiologists

Introductiono The sociological perspective is that

health is not the problem. Health is a symptom of the problem–social stratification and social inequality.

o The sociological perspective is that health inequalities are produced by the unequal distribution of resources, opportunities, limitations, and demands.

Evidence for Social Causes of Health

There is consistent evidence that race/ethnicity and SES are associated with health and well-being across the life course.

Infant Mortality Rates,* by Race and Hispanic Ethnicity of Mother — United States, 2000, 2005, and 2010

Fundamental Social Causes

Both race and SES may be viewed as fundamental social causes of health and well-being.

The Fundamental Social Causes explanation suggests that people who occupy relatively high social positions might be advantaged with regard to health and longevity because their position in the social hierarchy embodies resources like social capital, knowledge, money, power, and prestige that can be used in different ways to avoid health-risks and to adopt health-protective behaviors and strategies.

Fundamental Social Causes

o According to the fundamental social causes explanation, when new health-risk factors arise, when new health-related information emerges, or when new treatment technologies develop, those who command the most resources are best able to avoid the risk factors and take advantage of the protective factors.

Fundamental Social Causes

o When innovations (e.g., cancer screens) beneficial to health are developed, their implementation necessarily occurs within the context of existing inequalities in knowledge, money, power, prestige, and social connections.

Fundamental Social Causes

o Diseases, risk factors, and protective factors come and go.

o Social conditions are described as “fundamental social causes” of health and longevity because their effects persist even when diseases and relevant risk and protective factors change.

Policy Implications?To reduce disparities in health, we must first

address the underlying inequality driving these disparities.

“Pretax income inequalities have increased in many countries. A policy of not redressing this through the tax and benefit system, linked to lack of investment in public goods that brings the benefits of richer communities to all, will damage health.” Michael Marmot

Focus on interventions that are available to all, regardless of social characteristics.