The social determinants of health (SDH) are the non-medical factors that influence health

outcomes. They are the conditions in which people are born, grow, work, live, and age, and the
wider set of forces and systems shaping the conditions of daily life. These forces and systems
include economic policies and systems, development agendas, social norms, social policies and
political systems.
The SDH have an important influence on health inequities - the unfair and avoidable differences in
health status seen within and between countries. In countries at all levels of income, health and
illness follow a social gradient: the lower the socioeconomic position, the worse the health.
The following list provides examples of the social determinants of health, which can influence
health equity in positive and negative ways:
• Income and social protection
• Education
• Unemployment and job insecurity
• Working life conditions
• Food insecurity
• Housing, basic amenities and the environment
• Early childhood development
• Social inclusion and non-discrimination
• Structural conflict
• Access to affordable health services of decent quality.
The UK Black report (Inequalities in Health: The Black Report by Douglas Black) and The
Health Divide reports considered two primary mechanisms for understanding how social
determinants influence health: cultural/behavioural and materialist/structuralist. The cultural/
behavioral explanation is that individuals' behavioural choices (e.g., tobacco and alcohol use, diet,
physical activity, etc.) were responsible for their development and deaths from a variety of diseases.
However, both the Black and Health Divide reports found that behavioral choices are determined by
one's material conditions of life, and these behavioral risk factors account for a relatively small
proportion of variation in the incidence and death from various diseases.
The materialist/structuralist explanation emphasises the people's material living conditions. These
conditions include availability of resources to access the amenities of life, working conditions, and
quality of available food and housing among others. Within this view, three frameworks have been
developed to explain how social determinants influence health.
Diseases of poverty are diseases that are more prevalent in low-income populations. They include
infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is
one of the major social determinants of health. Poverty increases the chances of having these
diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to
health services contributes towards poor health behaviour. At the same time, these diseases act as a
barrier for economic growth to affected people and families caring for them which in turn results
into increased poverty in the community.

Development And Health

SDG Goal 3: Ensure healthy lives and promote well-being for all at all ages
3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all
countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per 1,000 live births.
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and
combat hepatitis, water-borne diseases and other communicable diseases.
3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through
prevention and treatment and promote mental health and well-being.
3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and
harmful use of alcohol.
3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents.
3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for
family planning, information and education, and the integration of reproductive health into national
strategies and programmes.
3.8 Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential
medicines and vaccines for all.
3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and
air, water and soil pollution and contamination.
3.A Strengthen the implementation of the World Health Organization Framework Convention on
Tobacco Control in all countries, as appropriate.
3.B Support the research and development of vaccines and medicines for the communicable and
noncommunicable diseases that primarily affect developing countries, provide access to affordable
essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS
Agreement and Public Health, which affirms the right of developing countries to use to the full the
provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide access to medicines for all.
3.C Substantially increase health financing and the recruitment, development, training and retention
of the health workforce in developing countries, especially in least developed countries and small
island developing States.
3.D Strengthen the capacity of all countries, in particular developing countries, for early warning,
risk reduction and management of national and global health risks.

Social inequality occurs when resources in a given society are distributed unevenly, typically
through norms of allocation, that engender specific patterns along lines of socially defined
categories of persons. It is the differentiation preference of access of social goods in the society
brought about by power, religion, kinship, prestige, race, ethnicity, gender, age, sexual orientation,
and class. Social inequality usually implies the lack of equality of outcome, but may alternatively be
conceptualised in terms of the lack of equality of access to opportunity. The social rights include
labor market, the source of income, health care, and freedom of speech, education, political
representation, and participation.
Meritocracies—that is, that their societies exclusively distribute resources on the basis of merit.
The term "meritocracy" was coined by Michael Young in his 1958 dystopian essay "The Rise of the
Meritocracy" to demonstrate the social dysfunctions that he anticipated arising in societies where
the elites believe that they are successful entirely on the basis of merit,
Gender as a social inequality is whereby women and men are treated differently due to
masculinity and femininity by dividing labor, assigning roles, and responsibilities and allocating
social rewards. Sex and gender-based prejudice and discrimination, called sexism, are major
contributing factors to social inequality. Most societies, even agricultural ones, have some sexual
division of labour and gender-based division of labour tends to increase during industrialization.The
emphasis on gender inequality is born out of the deepening division in the roles assigned to men
and women, particularly in the economic, political and educational spheres.
Health inequalities can be defined as differences in health status or in the distribution of health
determinants between different population groups. Health inequalities are in many cases related to
access to health care. In industrialized nations, health inequalities are most prevalent in countries
that have not implemented a universal health care system, such as the United States. Because of the
US health care system is heavily privatised, access to health care is dependent upon one's economic
capital; Health care is not a right, it is a commodity that can be purchased through private insurance
companies (or that is sometimes provided through an employer). The way health care is organised
in the U.S. contributes to health inequalities based on gender, socioeconomic status and race/
ethnicity. As Wright and Perry assert, "social status differences in health care are a primary
mechanism of health inequalities". In the United States, over 48 million people are without medical
care coverage. This means that almost one sixth of the population is without health insurance,
mostly people belonging to the lower classes of society.
While universal access to health care may not completely eliminate health inequalities, it has been
shown that it greatly reduces them. In this context, privatisation gives individuals the 'power' to
purchase their own health care (through private health insurance companies), but this leads to social
inequality by only allowing people who have economic resources to access health care. Citizens are
seen as consumers who have a 'choice' to buy the best health care they can afford; in alignment with
neoliberal ideology, this puts the burden on the individual rather than the government or the
community. Access to health care is heavily influenced by socioeconomic status as well, as
wealthier population groups have a higher probability of obtaining care when they need it.

Social exclusion is the social disadvantage and relegation to the fringe of society. It is a term used
widely in Europe and was first used in France. It is used across disciplines
including education, sociology, psychology, politics and economics.
Social exclusion is the process in which individuals are blocked from (or denied full access to)
various rights, opportunities and resources that are normally available to members of a different
group, and which are fundamental to social integration and observance of human rights within that
particular group (housing, employment, healthcare, civic engagement, democratic participation,
and due process).
Alienation or disenfranchisement resulting from social exclusion can be connected to a
person's social class, race, skin colour, religious affiliation, ethnic origin, educational status,
childhood relationships, living standards, and or political opinions, and appearance. The outcome of
social exclusion is that affected individuals or communities are prevented from participating fully in
the economic, social, and political life of the society in which they live. This may result in
resistance in the form of demonstrations, protests or lobbying from the excluded people.
Health equity arises from access to the social determinants of health, specifically from wealth,
power and prestige. Individuals who have consistently been deprived of these three determinants are
significantly disadvantaged from health inequities, and face worse health outcomes than those who
are able to access certain resources. It is not equity to simply provide every individual with the
same resources; that would be equality. In order to achieve health equity, resources must be
allocated based on an individual need-based principle.