Cited by 3,861Health disparities and outcomesPublic Health and Social InequalitiesPublic Health Policies and Education

The social determinants of health: It’s time to consider the causes of the causes

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Braveman, Paula, Gottlieb, Laura·2014·Public Health Reports®

Abstract

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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Crossref · 10.1177/00333549141291s206

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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”
  • 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”

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Authors
Braveman, P., & Gottlieb, L.
Affiliations
University of California, San Francisco (US)
Corresponding author
Braveman, Paula
Venue
Public Health Reports®
Published
2014-01
Volume
129
Issue
1_suppl2
Pages
19-31
ISSN
  • 0033-3549 (ISSN-L)
  • 1468-2877
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
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

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