Epidemiology · Reference
What are social determinants of health?
Social determinants of health are the non-medical conditions in which people are born, grow, live, work and age. These conditions — shaped by money, power and resources — are widely recognised as major drivers of health outcomes and of avoidable differences in health between groups.
What counts as a social determinant
The World Health Organization groups social determinants into the everyday circumstances of life and the structural drivers that shape them. Everyday conditions include income and social protection, education, employment and working conditions, food security, housing, and access to affordable health services. Structural drivers include economic policies, social norms, governance and political systems that distribute money, power and resources unequally. Because these factors operate well outside the clinic, they are described as the "causes of the causes" of ill health — the upstream conditions that influence the more proximate biological and behavioural factors.
The Dahlgren–Whitehead model
A widely recognised way to picture social determinants is the Dahlgren–Whitehead "rainbow" model (1991). It places the individual at the centre with fixed factors such as age, sex and constitution, then surrounds them with successive layers: individual lifestyle factors; social and community networks; living and working conditions (housing, education, work environment, water and sanitation, health services); and, in the outermost arc, general socioeconomic, cultural and environmental conditions. The layered design makes the point that individual behaviour sits within — and is constrained by — wider social and economic conditions, so interventions can target any layer.
Why they matter for population health
The distribution of social determinants explains much of the social gradient in health — the consistent observation that health improves stepwise as social and economic position rises. Because these conditions are unequally distributed, they are the principal route through which health equity is gained or lost. The WHO Commission on Social Determinants of Health concluded that acting on these conditions is essential to reduce avoidable health gaps, and many public-health strategies now aim "upstream" at the determinants rather than only at downstream disease.
Studying social determinants
Epidemiologists study social determinants by linking health outcomes to area-level and individual measures of social position, such as deprivation indices, income, education and occupation. Reporting frameworks encourage disaggregation across these dimensions so that gradients become visible. A persistent methodological challenge is confounding, because social factors are densely interrelated, and reverse causation, because ill health can itself reduce income or employment. Longitudinal cohort designs and natural experiments are often used to strengthen causal inference about how conditions shape health over the life course.
Key facts
At a glance
- Definition: Conditions where people are born, live, work and age
- Key body: World Health Organization (WHO)
- Model: Dahlgren–Whitehead rainbow model (1991)
- Examples: Income, education, housing, food, employment
- Also called: Upstream factors; "causes of the causes"
Common questions
FAQ
What are examples of social determinants of health?+
Examples include income and social protection, education, employment and working conditions, food security, housing and basic amenities, the surrounding environment, social inclusion, and access to affordable health services. The WHO also counts structural drivers such as economic and social policy among them.
What is the Dahlgren–Whitehead model?+
It is a layered "rainbow" diagram from 1991 that places the individual at the centre and surrounds them with concentric layers of influence: lifestyle factors, social and community networks, living and working conditions, and broad socioeconomic, cultural and environmental conditions. It illustrates how individual health sits within wider social structures.
How do social determinants relate to health equity?+
Social determinants are unequally distributed across society, and that uneven distribution is the main route through which health inequities arise. Acting on the conditions in which people live is therefore central to improving health equity, according to the WHO Commission on Social Determinants of Health.
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