Determinants of Health: A Journey Through Time

The World Health Organization defines the Social Determinants of Health (SDH) as non-medical factors that influence health outcomes (2023). To take a bigger dive into the research on SDH, I looked at several different articles from different decades to look for discrepancies and perspectives.

When I began my search for articles on SDH, I initially delved into the archives of the 1960s. In Macgregor's work (1961), the SDH were categorized into three key aspects: individual health behavior, community organizations and strategies for addressing group health issues, and the social structure responsible for planning and delivering community healthcare.

The individual behavior aspect pertains to personal characteristics such as independence, self-reliance, and one's approach to dealing with illness. Essentially, it reflects one's ability to adapt to illness and move forward with a suitable plan. The community behavior aspect is somewhat self-explanatory, encompassing the influence of social institutions and health-related activities within the community.

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The social structure component centers on the community's leaders, those responsible for implementing community organizations. In the case study of the Great Plains community mentioned in the article, it was suggested that members of the medical profession, county commissioners, men's service clubs, and female-dominated groups engaged in leadership in health education and welfare played crucial roles in shaping the community's social structures.

My journey through the 1970s led me to an article that focused on a theoretical framework for understanding health service utilization. Similar to the previous article, this framework had a three-pronged approach, concentrating on individual, societal, and health service factors (Andersen & Newman, 1973). This time, the focus was on how these factors interact and highlighted that societal factor, particularly technology and norms, are the primary drivers of resources and equitable distribution. Unfair distribution was shown to lead to suboptimal medical outcomes, making societal determinants the cornerstone of health, ensuring accessibility and structure.

Moving ahead to 1990s, Eric Brunner's (1997) work focused on the stress experienced by individuals in lower socioeconomic status. The chronic stress associated with social status, financial constraints, self-esteem, and other psychosocial factors was found to put individuals at a higher risk of poor health outcomes. These characteristics, in turn, influenced behavioral factors such as smoking and dietary choices.

Stepping into the new millennium, Braveman and Gottlieb's (2014) study underscored the profound impact of social factors that extend beyond the realm of medical care. Through a retrospective lens, it explored how medical care alone cannot be solely responsible for the significant increase in life expectancy over the years. Improved resources, living conditions, dietary choices, hygiene, and access to clean water emerged as pivotal factors contributing to enhanced life expectancy.

A comprehensive literature review revealed that income, education, and employment play substantial roles in shaping an individual's health (Braveman & Gottlieb, 2014). Studies indicated that almost half of the deaths occurring in the United States could be directly linked to these factors, with an emphasis on lack of education. This signifies the critical importance of addressing social determinants in understanding and improving public health.

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It is evident that SDH have evolved significantly throughout the years. There are many more factors considered compared to relying on one’s individual’s resiliency. Race, age and gender among other demographics have become transparent influences with SDH. Although I believe individual health behaviour continues to be a major element in SDH, There is a further need to focus on preventative medicine and wellness practice. This is done by ensuring individual’s access to the appropriate resources, like financial aid and diet. Throughout the years it is noted how the government can be a conduit to resources, with progressive concerns for public resources compared to the private sector.

Access to information and further education through remote care is a sector that will need to be considered as high importance for the future. With consideration to the pandemic and the gaining population remote care can provide the education and guidance patients need in a timely manner to avoid medical emergencies.

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Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 95-124.

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.

Brunner, E. (1997). Socioeconomic Determinants of Health: Stress and the Biology of Inequality. BMJ: British Medical Journal, 314(7092), 1472–1476. http://www.jstor.org/stable/25174608

Macgregor G. (1961). Social determinants of health practices. American journal of public health and the nation's health, 51(11), 1709–1714. https://doi.org/10.2105/ajph.51.11.1709

World Health Organization. (2023). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1