What is a social determinant of health? Back to basics.

Abstract

The objective of this essay is to clarify the understanding and use of Social Determinants of Health (SDOH) by exploring basic characteristics of ‘determinants’ and ‘fundamental causes,’ the ‘social,’ ‘structure,’ and ‘modifiability,’ and to consider theoretical and practical implications of this reconceptualization for public health. The analysis distinguishes Social Determinants of Health from other determinants of health. We define social determinants of health as mutable societal systems, their components, and the social resources and hazards for health that societal systems control and distribute, allocate and withhold, and that, in turn, cause health consequences, including changes in the demographic distributions and trends of health. A systems conceptualization holds concepts such as “race” as the creations of social systems and as having negative consequences, such as racism, when part of a racist system, but potentially ameliorative consequences when part of an anti-racist system. The integration of Social Determinants of Health into public health theory and practice may substantially expand the benefits of public health, but will require new theorizing, intervention research, education, collaboration, policy, and practice. Significance for public health Clarity in the conceptual and theoretical basis of SDOH creates critical opportunities for major advances in public health understanding and intervention. The questions raised here should continue to be reviewed and addressed. The refinement of concepts in public health serves to strengthen the tools of the discipline and further its goals, i.e., the understanding and improvement of the health of the public and the promotion of equitable access to societal resources for health for all.