social determinants of health social determinants of health the social determinants of health (sdoh) are the economic and social conditions that influence individual and group differences in health status. they are the health promoting factors found in one's living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual risk factors (such as behavioral risk factors or genetics) that influence the risk for a disease, or vulnerability to disease or injury. the distributions of social determinants are often shaped by public policies that reflect prevailing political ideologies of the area. social determinants of health: five key domains the world health organization says that "the social determinants can be more important than health care or lifestyle choices in influencing health." and "this unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements , and bad politics." issues of particular focus are social determinants of mental health, social determinants of health in poverty and social determinants of obesity. historical development social determinants of health visualization starting in the early 2000s, the world health organization facilitated the academic and political work on social determinants in a way that provided a deep understanding of health disparities in a global perspective. in 2003, the world health organization (who) europe suggested that the social determinants of health included: the social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food, and transportation. in 2008, the who commission on social determinants of health published a report entitled "closing the gap in a generation", which aimed to understand, from a social justice perspective, how health inequity could be remedied, and what actions could combat factors that exacerbated injustices. the work of the commission was based on development goals, and thus, connected sdh (social determinants of health) discourse to economic growth and bridging gaps in the healthcare system. this report identified two broad areas of social determinants of health that needed to be addressed. the first area was daily living conditions, which included healthy physical environments, fair employment, and decent work, social protection across the lifespan, and access to health care. the second major area was distribution of power, money, and resources, including equity in health programs, public financing of action on the social determinants, economic inequalities, resource depletion, healthy working conditions, gender equity, political empowerment, and a balance of power and prosperity of nations. the 2010 affordable care act (aca) established by the obama administration in the united states, embodied the ideas put in place by the who by bridging the gap between community-based health and healthcare as a medical treatment, meaning that a larger consideration of social determinants of health was emerging in the policy. the aca established community change through initiatives like providing community transformation grants to community organizations, which opened up further debates and talks about increased integration of policies to create change on a larger scale. the 2011 world conference on social determinants of health, in which 125 delegations participated, created the rio political declaration on social determinants of health. with a series of affirmations and announcements, the declaration aimed to communicate that the social conditions in which an individual exists were key to understanding health disparities that individual may face, and it called for new policies across the world to fight health disparities, along with global collaborations. commonly accepted social determinants the united states centers for disease control and prevention (cdc) defines social determinants of health as "life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life." these include access to care and resources such as food, insurance coverage, income, housing, and transportation. according to a report by the center for migration studies of new york, the different social determinants of health are strongly correlated. people living in an area with one identified determinant also tend to be affected by other determinants. social determinants of health influence health-promoting behaviors, and health equity among the population is not possible without equitable distribution of social determinants among groups. a commonly used model that illustrate the relationship between biological, individual, community, and societal determinants is whitehead and dahlgren's model originally presented in 1991 and has been adapted by the cdc. additionally, within the united states, the healthy people 2030 is an objective-driven framework which can guide public health practitioners and healthcare providers on how to address social determinants of health at the community level. in canada, these social determinants of health have gained wide usage: income and income distribution; education; unemployment and job security; employment and working conditions; early childhood development; food insecurity; housing; social exclusion/inclusion; social safety network; health services; aboriginal status; gender; race; disability. the list of social determinants of health can be much longer. a recently published article identified several other social determinants . unfortunately, there is no agreed taxonomy or criteria as to what should be considered a social determinant of health. in the literature, a subjective assessment—whether social factors impacting health are avoidable through structural changes in policy and practice—seems to be the dominant way of identifying a social determinant of health. the increase of artificial intelligence (ai) being used in clinical care raises numerous opportunities for addressing health equity issues, yet clear models and procedures for data characteristics and design have not been embraced consistently across health systems and providers. gender this section is an excerpt from gender disparities in health. the world health organization (who) has defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." identified by the 2012 world development report as one of two key human capital endowments, health can influence an individual's ability to reach his or her full potential in society. yet while gender equality has made the most progress in areas such as education and labor force participation, health inequality between men and women continues to harm many societies to this day. while both males and females face health disparities, women have historically experienced a disproportionate amount of health inequity. this stems from the fact that many cultural ideologies and practices have created a structured patriarchal society where women are vulnerable to abuse and mistreatment. additionally, women are typically restricted from receiving certain opportunities such as education and paid labor that can help improve their accessibility to better health care resources. females are also frequently underrepresented or excluded from mixed-sex clinical trials and therefore subjected to physician bias in diagnosis and treatment. race this section is an excerpt from race and health. race and health refers to how being identified with a specific race influences health. race is a complex concept that has changed across chronological eras and depends on both self-identification and social recognition. in the study of race and health, scientists organize people in racial categories depending on different factors such as: phenotype, ancestry, social identity, genetic makeup and lived experience. "race" and ethnicity often remain undifferentiated in health research. differences in health status, health outcomes, life expectancy, and many other indicators of health in different racial and ethnic groups are well documented. epidemiological data indicate that racial groups are unequally affected by diseases, in terms or morbidity and mortality. some individuals in certain racial groups receive less care, have less access to resources, and live shorter lives in general. overall, racial health disparities appear to be rooted in social disadvantages associated with race such as implicit stereotyping and average differences in socioeconomic status. health disparities are defined as "preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations". according to the u.s. centers for disease control and prevention, they are intrinsically related to the "historical and current unequal distribution of social, political, economic and environmental resources". the relationship between race and health has been studied from multidisciplinary perspectives, with increasing focus on how racism influences health disparities, and how environmental and physiological factors respond to one another and to genetics. economics "economic stability is a social determinant that significantly impacts employees because it is an aspect of wellness that intersects with so many others." economic stability within households is essential for the health and well-being of families, neighborhoods and for local and national economies. "economic security is having stable, sufficient income to meet basic needs while economic insecurity is living in a household with incomes below 200 percent of the federal poverty level." according to child welfare league of america (cwla), economic stability is described as the ability to obtain the resources that is necessary to one's life and well-being. according to the healthy people 2030, people with steady employment are less likely to live in poverty and more likely to be healthy, however, many people struggle with finding and keeping a job. "in the united states, 1 in 10 people live poverty, and many people cannot afford things like healthy foods, health care, and housing." social needs, environmental factors and barriers to accessing health care that are unaddressed could lead to worse health outcomes for people with lower incomes. additionally, residents of impoverished communities are at increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy. ongoing debates steven h. woolf, md of the virginia commonwealth university center on human needs states, "the degree to which social conditions affect health is illustrated by the association between education and mortality rates." reports in 2005 revealed the mortality rate was 206.3 per 100,000 for adults aged 25 to 64 years with little education beyond high school, but was twice as great (477.6 per 100,000) for those with only a high school education and three times as great (650.4 per 100,000) for those less educated. based on the data collected, the social conditions such as education, income, and race were dependent on one another, but these social conditions also apply to independent health influences. marmot and bell of the university college london found that in wealthy countries, income and mortality are correlated as a marker of relative position within society, and this relative position is related to social conditions that are important for health including good early childhood development, access to high quality education, rewarding work with some degree of autonomy, decent housing, and a clean and safe living environment. the social condition of autonomy, control, and empowerment turns are important influences on health and disease, and individuals who lack social participation and control over their lives are at a greater risk for heart disease and mental illness. early childhood development can be promoted or disrupted as a result of the social and environmental factors effecting the mother, while the child is still in the womb. janet currie's research finds that women in new york city receiving assistance from the special supplemental nutrition program for women, infants, and children (wic), in comparison to their previous or future childbirth, are 5.6% less likely to give birth to a child who is underweight, an indication that a child will have better short term, and long term physical, and cognitive development. several other social determinants are related to health outcomes and public policy, and are easily understood by the public to impact health. they tend to cluster together – for example, those living in poverty experience a number of negative health determinants. international health inequalities health gap in england and wales, 2011 census even in the wealthiest countries, there are health inequalities between the rich and the poor. researchers labonte and schrecker from the department of epidemiology and community medicine at the university of ottawa emphasize that globalization is key to understanding the social determinants of health, and as bushra (2011) posits, the impacts of globalization are unequal. globalization has caused an uneven distribution of wealth and power both within and across national borders, and where and in what situation a person is born has an enormous impact on their health outcomes. the organization for economic cooperation and development found significant differences among developed nations in health status indicators such as life expectancy, infant mortality, incidence of disease, and death from injuries. migrants and their family members also experience significant negatives health impacts. these