Social Determinants of Health (SDH)
}A definition of SDH themes
- Health systems as SDH
- Early child development
- Gender
- Social exclusion
- Unhealthy environments – slums
- Employment settings
- Lack of social protection
- Countries in crisis
Social determination of Health
The circumstances in which people are born, grow, work and
age and the systems put in place to deal with illness.
The conditions in which people live and die are, in turn,
shaped by political, social and economic forces.
“The social determinants of health refer to both specific
features and pathways by which societal conditions affect
health and that potentially can be altered by informed action.”
Source: Krieger N. A glossary for social epidemiology. J
Epidemiol Community Health
The Final report of the WHO Commission for Social
determenation of Health
Evidence is needed to guide action:
“Our children have dramatically different life chances
depending on where they were born.”
In Japan or Sweden they can expect to live more than 80 years;
in Brazil 72 years; India 63 Years.”
In countries at all levels of income, health and illness follow a
social gradient: the lower the socioeconomic position, the
worse the health.”
CSDH (2008) Closing the gap in a generation: health equity
through action on the social determinants of health. Final Report of CSDH. Geneva, World Health Organization. Executive
Summary.
Two categories of social determinants:
structural – “fundamental structures of social hierarchy” –
global determinants which, in turn affect countries and their
ability to tackle SDH:
intermediate - “socially determined conditions in which
people are born, grow, live, work and age” - local
Health system: Lack of universal primary health care; high
rates of out of pocket health expenses
Challenges of early child development: physical, cognitive/
language, social/ emotional; going beyond controlling
childhood diseases
Lack of education and empowerment of women – need for
education, employment
Social exclusion
Socially determined lifestyles: obesity
Unhealthy environments - rapidly expanding “slums”
Employment settings - unemployment, informal sector
employment
Lack of social protection in illness, for elderly, disabled
persons
Countries in crisis
Major Social Determination
of Health
Health system: Lack of universal primary health care; high
rates of out of pocket health expenses
Challenges of early child development: physical, cognitive/
language, social/ emotional; going beyond controlling
childhood diseases
Lack of education and empowerment of women – need for
education, employmentSocial exclusion
Socially determined lifestyles: obesity
Unhealthy environments - rapidly expanding “slums”
Employment settings - unemployment, informal sector
employment
Lack of social protection in illness, for elderly, disabled
persons
Countries in crisis.

We remain hopeful for good outcomes for the health of the
people