The Social Determinants of Health: A Call for Transformative Policy Change

Written by Toba Bryant, Associate Professor, Faculty of Health Sciences, Ontario Tech University, Canada.

Much of public discourse and public health activity continues to be focused on genetics, bodily systems, and health-related behaviour as being the primary factors shaping health, despite extensive evidence of their minor role in shaping health outcomes. Rather, it is people’s living and working conditions — the social determinants of health – that are essential to understanding health. Factors such as growing social inequalities that lead to unequal health outcomes.

It is also being recognized that these living and working conditions are shaped by much broader factors involving aspects of the politics and economics of the society and the powerful actors that are behind the form and processes that the structures take. The people working in these areas – – public policy, political, economy, political, science, and critical sociology – – are usually not considered to be part of the social determinants of health world, but indeed they are. In this special care has been taken to include their voices such that their understandings of these factors are essential for those who are concerned with improving the quality and distribution of the social determinants of health.

Understanding the importance of social determinants in shaping health and wellbeing has been recognized as early as antiquity. During the mid-nineteenth century, Engels and Virchow identified living and working conditions as the main determinants of health and wellbeing. Indeed, a considerable research literature documents the importance of material and social conditions in homes, workplaces and communities on health. Yet, ensuring the quality and equitable distribution of the social determinants through public policy remains challenging especially in a neoliberal political and economic environment driven by austerity public policies that reduce public social and health spending.

During the COVID-19 pandemic, mainstream media began to recognize the social determinants and identify groups that had increased risk of contracting the disease. Low-income and racialized populations had increased risk because of their living and working conditions. Many had jobs that could not be performed remotely. They were grocery store cashiers and shelf stockers, cleaners, custodians among others who had minimum wage jobs. Some lived in overcrowded housing and travelled on public transit to commute to and from work. They therefore had an elevated health risk as a result of their daily contacts with others. In short, their living and working conditions made it impossible to comply with social distancing requirements. While governments in most western countries implemented income and other programs to stem the spread of the disease, a number of countries removed these measures when the pandemic waned. These programs did little to address the systemic causes of social and health inequalities.

Improving the quality and distribution of social determinants requires transformative public policy that can not only reform but also transform existing political and economic systems. The current concern among some national governments with reducing deficits has fueled affordability and other crises in the world and increased income and health inequalities.

The Handbook on the Social Determinants of Health is a timely volume that examines these issues in depth and identifies the way forward. It brings together contributors from across disciplines in the social sciences and health who apply a critical perspective to these issues. While some contributors do not explicitly identify the social determinants of health, their insights make clear the implications for the social determinants. From their critical perspective, ensuring the quality of social determinants means ensuring secure employment, wages and social protections, access to affordable and decent housing, among others and recognizing these issues as rights for the Global North and South.