Understanding Social Determinants of Health

Health is a dynamic state of complete physical, mental, spiritual, and social well-being and not merely the absence of disease or infirmity.

Three measures were used in an analysis performed to estimate economic burden of health disparities in the United States (1) direct medical costs of health inequalities, (2) indirect costs of health inequalities and (3) costs of premature death.

• Between 2003 and 2006 the combined costs of health inequities and premature death in the United States were $1.24 trillion.
• Eliminating health disparities for minorities would have reduced direct medical expenditures by $229.4 billion for t he years 2003-2006.
• Between 2003 and 2006, 30.6% of direct medical care expenditures for African Americans, Asians and Hispanics were excess costs due to health inequalities.
• Eliminating health inequalities for minorities would have reduced indirect costs associated with illness and premature death by more than one trillion dollars between 2003 and 2006.

(LaVeist, TA 2009)

Health Equity is the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”

“Health equity is social justice in health.” - Paula Braveman

“When it comes to health, equity is a matter of life and death.” - WHO Leader Margaret Chan

What is Health Equity
Health Equity Framework
Path to Health Equity

Social Determinants of Health are the circumstances in which people are born, grow, live, learn, work, and age, which are shaped by a set of forces beyond the control of the individual. They are intermediate determinants of health, ‘down stream’ from the Structural Determinants. They include material circumstances, and psychosocial and behavioral characteristics. They include the living and working conditions of people, such as their pay, access to housing, or medical care.

Structural Determinants are the ‘root causes’ of health inequities, because they shape the quality of the Social Determinants of Health experienced by people in their neighborhoods and communities. Structural determinants include the governing process, economic and social policies that affect pay, working conditions, housing, and education. The structural determinants affect whether the resources necessary for health are distributed equally in society, or whether they are unjustly distributed according to race, gender, social class, geography, sexual identity, or other socially defined group of people.

“Expanding the Boundaries” - NACCHO
“A New Way to Talk About the Social Determinants of Health” – Robert Wood Johnson Foundation
“The Hurrider I Go the Behinder I Get” – Stephen Bezruchka
“The Future is Born Every day” – American Journal of Public Health
“Layers of Inequality: Power, Policy, and Health” – American Journal of Public Health
“Race, Racial Inequality and Health Inequities: Separating Myth from Fact” – Smedley, Jeffries, Adelman, and Cheng
"The Economic Burden of Health Inequalities in the United States" - Joint Center for Political and Economic Studies