Social Determinants of Health

What are social determinants of health?

Widespread scientific evidence has identified a strong relationship between health and social factors. Social factors make up the conditions, environments and settings that impact overall quality of life. Wilkinson and Marmot (2003) labelled social factors that affect health outcomes as 'social determinants of health'.

"The environments in which we are born, grow, live, work and age can have stronger influences on our health than our genetic family history or behavioural risk factors." – The Agency for Clinical Innovation

Social determinants of health can either strengthen or undermine individual and community health. They often extend inwardly to affect health behaviours and biomedical considerations that are part of a person's individual lifestyle and genetic make-up.

Social determinants of health include:

• income,
• education,
• conditions of employment,
• housing,
• residential environment,
• social capital,
• social exclusion,
• early life.

Why is addressing social determinants of health important?

In 2016, the Australian Institute of Health and Welfare found that people living in the lowest socioeconomic areas compared to the highest socioeconomic areas were:

• 1.6 times as likely to have at least 2 chronic conditions
• likely to live 3 years less on average 
• 30% more likely to have a low birthweight baby
• 3.6 times as likely to be exposed to tobacco smoke inside the home (children)
• likely to spend less on medical and health care
• twice as likely to delay seeing or not see a dental professional

 They also found that:

• a higher proportion of people with an employment restriction due to a disability lived in the lowest socioeconomic areas (26%) than in the highest socioeconomic areas (12%).
• unemployed people were 1.6 times as likely to use cannabis, 2.4 times as likely to use methamphetamines and 1.8 times as likely to use ecstasy as employed people.
  
• people reporting the worst mental and physical health were twice as likely to live in a poor-quality or overcrowded dwelling.

One study (Brown et al. 2012)  suggested that if the health gap between the most and least disadvantaged were closed Australia could be spared:

• $2.3 billion in annual hospital costs, and
• $5.3 million in Pharmaceutical Benefits Scheme prescriptions.

The World Health Organisation has made recommendations on what is required to close the health gap through action on social determinants. This includes adopting a whole of government approach with policies and interventions from all sectors and levels of society. In Australia, a major focus for closing the gap is with Indigenous health.

Despite a push towards tackling health inequalities, the complicated relationship between social determinates continues to challenge conventional policy. Current research is focused on better understanding the causal links between social determinants and health outcomes, and which policy areas might lead to better health outcomes. These policy areas include:

• monitoring and evaluation,
• data availability,
• extension of reporting on socioeconomic variables,
• health and welfare linkage,
  
• additional longitudinal data. 

Addressing social disparities using integrated care

The aging population and the changing burden of disease, especially the prevalence of long-term conditions, requires coordination between health and social care. Equitable access to traditional health and care services plays an important part in determining the health of the individual and the population. A focus on social determinants of health is critical for health equity, especially for vulnerable populations.

The NSW Integrated Care Implementation team is continuously working to establish policies that address social determinants of health by positively influencing social and economic conditions and supporting changes in individual behaviour. These policies aim to improve health outcomes for vulnerable populations over time.

The current NSW Integrated Care scaled initiatives focus on improving the health outcomes of our vulnerable communities by addressing social determinants of health to close the health gap. The scaled initiatives address social determinants in the following ways:

Information on a broader selection of  NSW Integrated Care initiatives with a social determinants of health focus can be found on the Agency for Clinical Innovation website.

Risk of Hospitalisation Algorithm and social determinants of health

The Risk of Hospitalisation (RoH) Algorithm is based on an extensive list of demographic and socioeconomic factors as well as hospitalisation and medical history. The RoH algorithm covers a wide range of chronic conditions and identifies which patients are likely to benefit from integrated care interventions.

The NSW Integrated Care Implementation team (ICI) is currently working with NSW Local Health Districts (LHDs), Specialty Health Networks (SHNs) to create transformation plans, fact sheets, monitoring and evaluation toolkits, program logics, evaluation questions and data plans. The data and the tools it inspires create the foundation for the policies and initiatives currently being developed to address the social determinants of health.