Social Determinants of Health: Why Where You Live Shapes How Long You Live
In short: Social determinants of health are the conditions in which people are born, grow, work, live and age — income, education, housing, gender, caste and access to services — that drive most health inequalities.
The idea
WHO's Commission on Social Determinants of Health (2008) concluded that 'social injustice is killing people on a grand scale.' Health care alone cannot fix gaps caused by poverty, poor housing, unsafe work and discrimination.
The Dahlgren–Whitehead rainbow
This widely used 1991 model shows layers of influence: individual factors (age, sex, genes), lifestyle, social and community networks, living and working conditions, and broad socio-economic, cultural and environmental conditions.
Determinants in Nepal
Health outcomes in Nepal vary by province, wealth, education, caste/ethnicity, gender and geography. Remote mountain districts, Dalit and marginalised communities, and the poorest households tend to have lower use of services and higher mortality. Labour migration, remittances and urbanisation add new layers.
Acting on determinants
Effective responses include cash transfers, girls' education, safe water and sanitation, social health insurance, safe housing and 'Health in All Policies' — making health a consideration in decisions on roads, agriculture, education and labour.
Key takeaways
- Most health inequality is caused by social and economic conditions.
- The Dahlgren–Whitehead rainbow is a standard teaching model.
- Health in All Policies applies health thinking across sectors.
Common questions
What are the five key determinants?
Common groupings are economic stability, education, health care access, neighbourhood/environment and social/community context.
Are genes a social determinant?
No, genes are individual factors; social determinants are the conditions around people.
References
Educational content by PHC-Nepal. It does not replace advice from a qualified health professional.