What are the social determinants of health?
Differences in health status between individuals or groups that are avoidable, unfair and unjust are known as 'health inequities'. PROGRESS-Plus is a useful acronym to identify and classify a range of social factors that are commonly associated with health inequities. These are often referred to as 'social determinants of health'. |
P Place of residence Place of residence often refers to whether someone lives in a rural area or in a city. It may also refer to the income level of the country in which they live, or characteristics of their home environment, neighbourhood, city or region. Wealth is important, but factors such as access to green space or public transport; local air pollution and water quality can also contribute to disadvantage and influence health. |
R Race, ethnicity, culture and language There are many differences in health outcomes across races, ethnicities, cultures, and languages. Race is usually considered to be biologically determined, whereas culture and ethnicity include social aspects. Each of these factors can impact health, and may have greater negative impacts on the health of people in minoritised groups. Cultural beliefs and practices or language barriers can disadvantage certain groups from accessing health information and services; and cultural norms influence many health-related behaviors including dietary habits and exercise. |
O Occupation Occupation includes factors such as unemployment, underemployment, informal workers, and unsafe working environments. Occupational status is strongly related to a range of health outcomes; and certain occupations have been shown to be associated with higher mortality and morbidity rates than others. Employee benefits and employer-funded insurance systems are related to a person’s occupation and may impact peoples opportunities for optimum health. |
G Gender and sex Biological and gender-based differences result in varied health outcomes. Biological differences may or may not be regarded as inequities because many unavoidable sex-related differences (e.g. between men and women) exist. Gender refers to socially constructed roles that can drive (avoidable) health inequities. Examples include differential exposure to household hazards or, in areas where women travel for water or to wash clothes – exposure to stagnant water. Women might also be more affected by gender-based violence or lack of decision-making power. Gendered norms can effect health-seeking behaviour, health status, and access to health services. |
R Religion Religion contributes to inequities when access to health services is limited for a subgroup of the population because of their religious affiliation (or lack of religion). For example - when a person declines health services based on religious beliefs, and when adhering to religious beliefs is not an individual choice but is imposed by the community or family – health inequities exist. |
E Education People with a higher level of education are more likely to have healthier lifestyles - including being more physically active, receiving primary health care, and not smoking. Well-educated people are more likely to have more knowledge about health and preventive health measures; and are more likely to receive high incomes. The availability and choice of education is influenced by the environment in which a person lives. |
S Socioeconomic status A person's socioeconomic status (SES) has an important influence on their health status. Higher SES usually means improvements in many determinants of health such as better living conditions and access to fresh and nutritious foods, as well as access to higher quality education. Inequalities in income impact a person’s life chances and therefore impact health. |
S Social capital Social capital refers to social relationships and networks. It includes marriage, family relationships; interpersonal trust between members of a community or neighbourhoods; civic participation and the willingness of members of a community to assist each other. Social isolation; low levels of social participation and community connectedness can negatively impact health. |
+ Plus characteristics 1) Personal characteristics associated with discrimination (e.g. age, disability) 2) Features of relationships or other vulnerable groups (e.g. smoking parents, excluded from school) 3) Time-dependent relationships (e.g. leaving the hospital, respite care, other instances where a person may be temporarily at a disadvantage) |