The social determinants of health: It’s time to consider the causes of the causes
Open accessAbstract
During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)-the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use "medical care" rather than "health care" to refer to clinical services, to avoid potential confusion between "health" and "health care." The World Health Organization's Commission on the Social Determinants of Health has defined SDH as "the conditions in which people are born, grow, live, work and age" and "the fundamental drivers of these conditions." The term "social determinants" often evokes factors such as health-related features of neighborhoods (e.g., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors. Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes. This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social-and particularly socioeconomic-factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects. We also discuss challenges to advancing this knowledge and how they might be overcome.
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Differences in the distribution and impact of harmful and protective SDOH contribute substantially to health inequities.
“differences in the distribution and impact of harmful and protective social determinants of health (SDOH) contribute substantially to health inequities”
From Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications (2023) · cites this paper as Braveman & Gottlieb, 2014
Social determinants, including civil rights laws and their enforcement, affect health by affecting intermediate factors such as housing, employment, and transportation, which in turn affect the distribution of health risk and protective factors and the resources for prevention and treatment.
“Social determinants, including civil rights laws and their enforcement, affect health by affecting intermediate factors such as housing, employment, and transportation which, in turn, affect the distribution of health risk and protective factors, such as pathogens and environmental toxins, and the resources for prevention and treatment (Hahn, 1995, Williams et al., 2008, Braveman and Gottlieb, 201”
From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Braveman and Gottlieb, 2014
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Income Inequality in Health at All Ages: A Comparison of the United States and England
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Social Determinants of Health and Health-Care Solutions
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Commentary: The McKeown debate: time for burial
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Siegel, R. L., Miller, K. D., Wagle, N. S., & Jemal, A. (2023) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21763 · Cited by 16,303 · see citing works
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Then, Now, Next: Unpacking the Shifting Trajectory of Social Determinants of Health
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- Authors
- Braveman, P., & Gottlieb, L.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Braveman, Paula
- Venue
- Public Health Reports®
- Publisher
- SAGE Publications
- Published
- 2014-01
- Volume
- 129
- Issue
- 1_suppl2
- Pages
- 19-31
- ISSN
- 0033-3549 (ISSN-L)
- 1468-2877
- PMC
- PMC3863696
- OpenAlex
- W2162049040
- Cited by
- 3,861
- References
- 151
- Citations by year
- 2026: 479 · 2025: 549 · 2024: 580 · 2023: 553 · 2022: 471 · 2021: 398 · 2020: 279 · 2019: 179 · 2018: 159 · 2017: 110 · 2016: 53 · 2015: 34 · 2014: 10
- FWCI
- 9.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Public Health Reports (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Intellectum (Universidad de La Sabana) (submittedVersion, cc-by-nc-nd)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- social determinants of health, socioeconomic factors, income, wealth, biological mechanisms, neighborhood environment, health behavior, health disparities
- MeSH terms
- Delivery of Health Care, Health Status, Humans, Socioeconomic Factors, United States, Vulnerable Populations, Epigenesis, Genetic, Social Determinants of Health
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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