Social determinants and their unequal distribution: clarifying policy understandings

Abstract

Public health policy in older industrialized societies is being reconfigured to improve population health and to address inequalities in the social distribution of health. The concept of social determinants is central to these policies, with tackling the social influences on health seen as a way to reduce health inequalities. But the social factors promoting and undermining the health of individuals and populations should not be confused with the social processes underlying their unequal distribution. This distinction is important because, despite better health and improvement in health determinants, social disparities persist. The article argues that more emphasis on social inequalities is required for a determinants-oriented approach to be able to inform policies to address health inequalities.

Figure 1

Social Determinants of Health

Figure 2

Social Determinants of Health Inequalities

Figure 3

Proportion of Households with Incomes below 50% of Average Income, before and after Transfers, circa 1990