Social determinants of health
- Concept
The conditions in which people are born, grow, live, work and age, and how power and money are shared, weigh on health as much as medicine or more.
What it is
The social determinants of health are the conditions of daily life and the forces that shape them: the economy, policies, education, employment, housing and social protection. The WHO framework separates structural determinants (political context and social position by income, education, occupation, gender or ethnicity) from intermediary ones (material conditions, behaviours, psychosocial factors and the health system itself). When these conditions are shared unfairly, health inequities appear.
Worked example
- A made-up department has 5,000 live births a year in each wealth quintile (25,000 in all).
- Infant mortality per 1,000 live births: quintile 1 (poorest) 24; quintile 2, 18; quintile 3, 14; quintile 4, 10; quintile 5, 6.
- Ratio between extremes: 24 / 6 = 4.0. Difference: 24 − 6 = 18 deaths per 1,000 live births.
- Each quintile contributes its rate × 5 deaths: (24 + 18 + 14 + 10 + 6) × 5 = 72 × 5 = 360 infant deaths a year.
- If everyone had the rate of quintile 5: 6 × 5 × 5 = 150 deaths. Excess: 360 − 150 = 210 a year.
- Relative excess: 210 / 360 = 58% of infant deaths (rounded).
- Reading: there is a gradient across all five steps, and more than half of the deaths are linked to social position.
Levels of determinants and examples of action
| Level | Examples | Typical action |
|---|---|---|
| Structural | Income, education, employment, gender, ethnicity, public policy | Social, economic and education policy |
| Intermediary: material conditions | Housing, safe water, sanitation, food | Infrastructure, food programmes |
| Intermediary: behaviours and psychosocial factors | Tobacco, physical activity, stress, support networks | Health promotion, healthy settings |
| Intermediary: health system | Insurance coverage, distance to services, quality | Primary care, care pathways, coverage |
Markers
- SDH
- Social gradient
- Inequity
- Quintile
In practice
- The effects show up in the consulting room: transport barriers, food insecurity or informal work explain missed check-ups and decompensations.
- Health situation analyses of Colombian territories describe the determinants of each municipality to set priorities.
Common pitfalls
- Calling any difference an inequity: differences by age or biology are not unfair in themselves.
- Looking only at the poorest group and forgetting the gradient across the whole scale.
- Blaming individual behaviour alone without seeing the conditions that produce it.
Test yourself
Think of the answer, then tap the question to see it.
How does WHO define the social determinants of health?
As the conditions in which people are born, grow, live, work and age, and the forces (power, money, resources) that shape those conditions.
What is the difference between health inequality and health inequity?
Inequality is any difference; inequity is a difference between social groups that is avoidable, unfair and systematic.
Infant mortality is 30 in the poorest quintile and 10 in the richest. What are the ratio and the difference?
Ratio = 30 / 10 = 3; difference = 30 − 10 = 20 deaths per 1,000 live births.
What is the social gradient in health?
Health improves step by step as social position rises, not only between poor and non-poor.
Elsewhere in DurgiPedia
Connections
Educational content on epidemiological and statistical methods; the examples use made-up numbers to teach the calculation. Not a clinical or legal guide: current Colombian rules are in the official sources.
Sources: Social determinants of health (World Health Organization, 2026); A Conceptual Framework for Action on the Social Determinants of Health (World Health Organization, 2010); Ley 1751 de 2015 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2015).
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Representative model, for educational purposes only.