Introduction

Abstract

Abstract The Introduction discusses the social determinants of health and health disparities. It defines these concepts, identifies key determinants, and provides a step-by-step overview of current knowledge of how social determinants influence health and produce health disparities. A critical mass of knowledge on the social determinants of health has accumulated, documenting associations, exploring causal pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the fundamental role of social factors in health. The questions are no longer whether social factors—such as economic hardship, living conditions, and discrimination—influence health and health disparities but, rather, how they do so and how best to intervene. Health disparities—differences in health between more and less advantaged social groups, such as wealthy people and poor people, or White people and African Americans—are the products of disparities in social determinants, including disparities in power and in access to key resources and opportunities that directly or indirectly affect health. The role of social determinants of health is often hidden because their health effects may not manifest for decades. We must look upstream—that is, at the beginning of long, often complex causal chains—to identify the most fundamental social factors that powerfully shape health and health disparities. Addressing only the more visible downstream factors may not be effective because upstream causes will continue to set in motion the causal chains leading to ill health.