What is the best definition of a social determinant of health group of answer choices?

Who do you think faces more risks in their line of work - a corporate worker with a desk job or a construction worker who helps build infrastructure? Of course, the construction worker faces considerably more risk than the desk worker because they have physically demanding tasks, such as heavyweight materials and working on heights!

This example demonstrates that, despite the lack of any medical-related related differences between these two people, they are both at vastly different levels of risk of ill-health. This speaks to how social factors can influence our health - namely, the 'social determinants of health'.

• In this explanation, we are going to ask what the 'social determinants of health' are.
• Next, we'll look at research that has been conducted on the social determinants of health.
• After that, we'll explore some of the inequalities associated with the social determinants of health.
• Finally, we'll take a close look at the social determinants of health in the UK.

Social determinants of health: definition

What are the social determinants of health, and why are some people less likely to live a long time or have a good quality of life than others? To answer these questions, we first need the definition of the social determinants of health.

According to Public Health England (2017), social determinants of health are“the broad social and economic circumstances that together influence health throughout the life course".

Put simply, social determinants of health are non-medical factors that affect health.

Social determinants of health: research

The Black Report (1980), commissioned to find the causes of social class inequalities in health, contained statistical evidence alongside what has proven to be an extremely influential framework for its interpretation. This report determined that economic inequality is the primary reason for health inequality, and that it could be improved by the re-distribution of resources.

The Acheson Report (1998) was commissioned by the New Labour government to further review the evidence on inequalities in health. In particular, it looked at the widening gap between those at the top and bottom of the social scale. It primarily addressed inequalities in the settings of schools, the workplace, and neighbourhoods.

The Marmot Review (2010) highlighted the gap in life expectancy between the richest and the rest of society, who not only die prematurely but spend more of their life in ill health. The Marmot Review set out key policy objectives based on the social determinants of health:

• Give every child the best start in life.

• Enable all children, young people, and adults to maximise their capabilities and have control over their lives.

• Create fair employment and good work for everyone.

• Ensure a healthy standard of living for everyone.

• Create and develop healthy and sustainable places and communities.

• Strengthen the role and impact of the prevention of ill-health.

Social determinants of health inequalities

Health inequalities can be defined as differential states of health and distribution of determinants of health between different demographic groups.

The differences are considered unequal because these can be removed by providing a fair environment and determined through social class, income, gender, ethnicity, and region.

Social class and health inequalities

The relationship between social class and healthcare is a complex one. Data shows that health chances deteriorate the lower the social scale people are, and there are significant differences between families. There will be health inequalities between houses in the same street.

Department for Work and Pensions (2022) states that the state pension age is currently 66 years for men and women. This will rise to 70 years in the next 50 years. This implies that an even greater proportion of working-class people will become sick and die before they retire, compared to the current figure of 20%. This figure is magnified for manual workers, as compared to professional and managerial workers.

Wilkinson and Marmot (2003) published a report for the WHO, which concluded that good health involves reducing levels of educational failure, reducing insecurity and unemployment, and improving the housing stock. Societies that seek to reduce inequalities will be the healthiest.

The rainbow model of the social determinants of health

Dahlgren and Whitehead (1991) presented the rainbow model of social determinants of health. It explained that health issues are linked with social factors. Hence, individuals' economic, social, and environmental condition determines their level of health and access to healthcare facilities.

In this model, different layers describe the influences on health, and the individuals are placed in the centre. The first layer is related to lifestyle, the second is related to social and community networks, the fourth is living and working conditions and the last is related to general conditions related to society, culture and environment.

This model is very useful in constructing different hypotheses related to determinants of health, and various research has already been conducted.

How does gender determine inequalities in health?

According to the House of Lords Library (2021), though life expectancy is higher among women than men in the UK, throughout their life, women are also likely to spend much more of their life in poor health than men.

Furthermore, since the 1980s, the rate of improvement of life expectancy has slowed down for women as compared to men.

Biological explanations of health inequalities in gender

Biological explanations include the fact that the female reproductive body can encounter more complications than its male counterpart. Women can suffer from menstrual problems, sickness associated with pregnancy (like hormone fluctuations and high blood pressure), as well as more frequent problems during menopause.

Social explanations of health inequalities in gender

Social explanations and behaviour choices also have an impact. Feminists state that women visit doctors more than men. However, this is not always due to more illness. Women find themselves in doctors' offices more often due to children and family care commitments. Men can also be reluctant to go to the doctor and often wait until symptoms are bad.

Hilary Graham describes how, when budgets are tight, women forego spending on themselves if they are alone during the day. This makes them more prone to illness. This supports Christine Delphy's notion of women sacrificing to give more to their male partners and children.

Though they have shorter life expectancies, men experience higher injury rates than women, so it is important to take lifestyle choices into account when thinking about gender differences. Alan Dolan's (2011) studies of working-class men show how male attitudes to health and risk-taking behaviour vary enormously due to economic circumstances. He challenges the idea of a homogenous culture of masculinity.

How important is the gender factor in health?

Plenty of research shows that women living in more disadvantaged areas live fewer years in 'good health' than those living in wealthy areas. However, it is worth noting that relative wealth trumps gender as an indicator of life expectancy. A man in a wealthy area will live longer than a woman in a deprived area.

How does ethnicity determine inequalities in health?

Ethnic health inequalities are very driven by wealth inequalities. For instance, because of their location generally in the lower classes, BAME (Black, Asian, and Minority Ethnic) groups are more likely to live in poverty with poorer quality housing.

Defining ethnicity is difficult in itself. Sociologists prefer this term to 'race', but it is still complex because it involves religion, culture, and nationality. Some people identify as being part of more than one ethnic group. This is important to keep in mind.

Sproston and Mindell (2006) identified that people from BAME groups are more likely to define themselves as suffering from 'poor health' than the white population. There is evidence to show that there are higher premature death rates for non-white men and women than for their white counterparts.

Genetic, cultural, and social class explanations of ethnic inequalities in health

There are a small number of rare genetic diseases that appear specifically in ethnic minorities, for example, sickle cell anaemia (a serious inherited blood disorder that affects one in 300 people of African-Caribbean descent).

There are some cultural factors that also affect health. For example, the South Asian community eats a highly saturated form of clarified butter called ghee, which could contribute to high levels of heart disease. The Muslim community, especially women, are prone to vitamin D deficiency due to limited or no skin exposure to the sun.

However, research overwhelmingly shows that social class is the main factor driving ethnic health. BAME groups are often in the working class and are therefore worse off socio-economically. Research by Richard Wilkinson emphasizes the importance of status in shaping health chances, and this research could be directly transferred onto BAME groups. As they are frequently located in the lower social classes and are subject to discrimination, it is logical that they have poorer health chances. The Acheson Report made recommendations that aimed to reduce ethnic health inequalities.

Regional factors in health inequalities

The Marmot Review (2010) indicated that within the UK, life expectancy differs by country. England has the highest expectancy at birth (78.3 years for men and 82.3 years for women), while Scotland has the lowest (75.4 years for men and 80.1 years for women). There can also be a wide range of health levels within large cities.

Shaw et al. (1999) looked at mortality rates before retirement age. Even when other factors were controlled, they found that region was a significant factor in living beyond retirement age. Their explanation was a mixture of spatial, social, and economic factors.

Robert Putnam (1995) shows how Émile Durkheim's concepts of social integration and anomie are still relevant in determining health chances across regions. Putnam used the term 'social capital' to refer to the social networks and trust that can exist in communities, enabling residents to participate together and have a general sense of wellbeing. This work was criticised, however, by Pevalin and Rose (2006), who argued that the influence of social capital is overshadowed by social deprivation.

Social determinants of health in the UK

Public Health England (2017) identifies that there are several health inequalities among demographics within the United Kingdom. They outline a variety of social determinants of health in the UK, such as:

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