Social determinants of health are social factors that influence our health. The World Health Organization (WHO) has described social determinants as:
...the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces [1].
The social determinants of health are considered to be largely responsible for health inequities [2, 3]—the unfair and potentially avoidable differences in health status seen within and between population groups. There is clear evidence that health and illness are not distributed equally within the Australian population. Variations in health status generally follow a gradient, with overall health tending to improve with improvements in socioeconomic position [4].
Socioeconomic position
In general, people from poorer social or economic circumstances are at greater risk of poor health, have higher rates of illness, disability and death, and live shorter lives than those who are more advantaged [5].
Indicators such as education, occupation and income can be used individually or combined to define socioeconomic position. The Australian Bureau of Statistics Area-based Index of Relative Socio-economic Disadvantage (Box 1), is a ranking based on geographic areas and frequently used by the AIHW to stratify the population by socioeconomic status.
Often, the gap between the lowest and highest socioeconomic groups is of greatest interest. Simple differences in measures, such as rates and prevalences, can be used to examine this gap—and this gap can be absolute (for example, a difference in rates) or relative (for example, the ratio between two rates) [6].
Box 1: The Index of Relative Socio-economic Disadvantage
The Index of Relative Socio-economic Disadvantage (IRSD) is one of four indices compiled by the ABS using information collected in the Census of Population and Housing [7]. This index represents the socioeconomic conditions of Australian geographic areas by measuring aspects of disadvantage. The IRSD scores each area by summarising attributes of their populations, such as low income, low educational attainment, high unemployment, and jobs in relatively unskilled occupations. Areas can then be ranked by their IRSD score and are classified into groups based on their rank. Any number of groups may be used—five is common.
If five categories are used, then the IRSD commonly describes the population living in the 20% of areas with the greatest overall level of disadvantage as 'living in the lowest socioeconomic areas' or the 'lowest socioeconomic group'. The 20% at the other end of the scale—the top fifth—is described as the 'living in the highest socioeconomic areas' or the 'highest socioeconomic group'.
It is important to understand that the IRSD reflects the overall or average socioeconomic position of the population of an area; it does not show how individuals living in the same area might differ from each other in their socioeconomic position.
Socioeconomically disadvantaged people are a priority population for health monitoring. The AIHW routinely uses available measures, such as the IRSD, to assess and report the health outcomes of socioeconomic groups. As socioeconomically disadvantaged people often experience significant health inequalities, the AIHW aims to investigate and monitor, where possible, which factors contribute to observed inequalities.
There is a complex interplay between health and welfare, where social factors such as an individual’s education, employment, and relationships can impact their overall health, and vice versa. The AIHW is seeking to expand its use of health and welfare data to further understand how social factors influence health and welfare.
References
- CSDH (Commission on Social Determinants of Health) 2008. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: WHO.
- Solar O & Irwin A 2010. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: WHO.
- Wilkinson R & Pickett K 2010. The spirit level: why equality is better for everyone. London: Penguin Books.
- Kawachi I, Subramanian SV & Almeida-Filho N 2002. A glossary for health inequalities. Journal of Epidemiology and Community Health 56:647–52.
- Mackenbach JP 2015. Socioeconomic inequalities in health in high-income countries: the facts and the options. In: Oxford textbook of global public health. Vol. 1. 6th edition. Oxford: Oxford University Press.
- Harper S, King NB, Meersman SC, Reichman ME, Breen N & Lynch J 2010. Implicit value judgements in the measurement of health inequalities. Milbank Quarterly 88(1):4–29.
- ABS 2013. Socio-Economic Indexes for Areas (SEIFA), 2011. ABS cat. no. 2033.0.55.001. Canberra: ABS.
