Social Determinants of Child Health: Concepts and Measures for Future Research

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According to the World Health Organization (WHO) Commission on Social Determinants of Health: “Health and health equity may not be the aim of all social policies but they will be a fundamental result.”1 Therefore, robust empirical evaluation of the effects of social policies on health outcomes is necessary to guide effective policymaking. In this paper, we review the empirical literature examining the effects of a key social determinant of health, family economic security, on child and family health outcomes; formulate a framework to understand possible mechanisms of effect; and introduce our development of a policy surveillance system to measure changes in state laws that affect social determinants of health. The goals of the paper are to inspire, guide, and facilitate rigorous empirical research on the effectiveness of laws and policies to reduce key deleterious social determinants of health and, therefore, support evidence-based policymaking for the promotion of health and health equity. We emphasize child and family outcomes because the foundation for health across the lifespan is strongly influenced by exposures early in life. Scientific consensus is emerging that developmental, biological, and social disruptions during early years of life are often the origins of adult conditions including cardiovascular disease, obesity, diabetes, smoking, drug use, and depression.2,3 Accumulating evidence is demonstrating that improved health trajectories beginning in childhood will result in improved health throughout the lifespan.4,5 The WHO’s seminal report, followed by the 2011 World Conference on Social Determinants of Health, strongly emphasized the importance of targeting child development to eliminate health disparities: “Early child development...has a determining influence on subsequent life chances and health through skills development, education, and occupational opportunities. Through these mechanisms, and directly, early childhood influences subsequent risk of obesity, malnutrition, mental health problems, heart disease, and criminality...Investment in the early years provides one of the great-