Defining Social Determinants of Health
The World Health Organization (WHO) defines social determinants of health as the conditions in which individuals are born, grow, live, work, and age, these being non-medical factors that influence health outcomes. These determinants are profoundly influenced by the distribution of wealth, power, and resources at both global and local levels. Mental health, which encompasses psychological and emotional well-being, is not merely the absence of mental illness. It is critical in influencing all aspects of an individual’s life, including physical health. Mentally healthy individuals contribute to the overall well-being of populations.
The WHO’s Conceptual Framework for Social Determinants of Health (CSDOH) elucidates how social, economic, and political factors such as income, education, occupation, gender, race, ethnicity, and culture shape an individual’s or population’s socio-economic status. These factors, in turn, determine health outcomes. This framework is pivotal in public health, guiding empirical research, enhancing our understanding of the underlying mechanisms, and informing policymaking by signposting or identifying intervention points.
Socioeconomic and political factors significantly influence an individual’s quality of life, environment, physical activities, and access to healthcare services. The CSDOH framework categorises these factors into two main groups: “structural determinants of inequities,” which pertain to socio-economic positions within the community or society, and “intermediary determinants,” which include material circumstances, behavioural and biological factors, and psychosocial circumstances.
Income inequality has significant adverse effects on health. On an individual level, those with lower incomes frequently experience chronic stress due to financial insecurity and the struggle to meet basic needs. This stress reduces their capacity to avoid risks and prioritise health. On a community level, areas with lower income levels often display reduced civic participation, higher crime rates, and unhealthy living conditions, all of which contribute to poorer health outcomes. Applying the SDOH framework to mental health is essential for understanding the causal factors leading to mental health disorders and for identifying pathways for intervention. In Sweden, for example, while many individuals report good health, many also report recurring mental and somatic issues such as headaches, low moods, and sleep difficulties. These problems vary across different demographic groups, with higher rates among girls, women, youth, and LGBTQ individuals compared to their counterparts.
Social inequalities are closely linked to an increased risk of mental disorders. Unemployed individuals report more psychosomatic problems compared to those who are employed. From 2008 to 2018, the prevalence of anxiety among individuals aged 16-84 remained relatively stable, with 54% of women and 33% of men reporting such issues in 2016.
Early interventions are crucial for improving mental health outcomes. Enhancing daily life conditions from pre-birth through the lifespan offers opportunities to improve individual and population mental health and reduce the risk of mental disorders. Mental disorders, including depression, anxiety, schizophrenia, and substance dependencies, often result from stress. Addressing both structural and intermediary determinants is essential for mental health, emphasising the need for comprehensive support services and accessible healthcare. The health system can advocate for and mediate the differential consequences of ill health in populations.
Understanding and addressing the social determinants of health on a global scale is vital for fostering healthier communities and improving mental health outcomes. By recognising the intricate interplay between socioeconomic factors and health, policymakers and public health professionals can develop targeted interventions to reduce health disparities and promote mental well-being. Building a world where everyone can thrive, regardless of their socio-economic circumstances, requires a concerted effort to address the root causes of health inequities.
The social determinants of health profoundly impact mental well-being. By leveraging frameworks like the WHO’s Conceptual Framework for Social Determinants of Health, we can better understand and address the factors contributing to mental health disorders. Early interventions and comprehensive support services are essential for improving mental health outcomes. By addressing these determinants, we can create healthier, more equitable communities globally, ensuring that all individuals can lead fulfilling and healthy lives.
Priscilla Benaya, Global Health Expert and Founder of Abtello.