Evidence supports the close relationship between people’s health and the living and working conditions which form their social environment (Wilkinson & Marmot eds. 2003). Factors such as socioeconomic position, conditions of employment, power and social support—known collectively as the social determinants of health—act together to strengthen or undermine the health of individuals and communities (see 'Social determinants of health in Australia' in Australia’s health 2020: data insights).

The World Health Organization (WHO) describes 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’ (CSDH 2008).

According to the WHO, social inequalities and disadvantage are the main reason for avoidable and unfair differences in health outcomes and life expectancy across groups in society.

This page provides selected data to monitor key social determinants of health in Australia.

See ‘Social determinants of health in Australia’ and ‘Housing conditions and key challenges in Indigenous health’ in Australia’s health 2020: data insights for in-depth discussion of social determinants of health.

What are the social determinants of health?

‘Social determinants of health’ has rapidly become a central concept in population and public health, leading to the emergence of new theoretical models and frameworks.

Although there is no single definition of the social determinants of health, there are common usages across government and non-government organisations.

In 2003, the World Health Organization Europe suggested that the social determinants of health included socioeconomic position, early life, social exclusion, work, unemployment, social support, addiction, food and transportation (Wilkinson & Marmot eds. 2003).

Other commonly accepted social determinants of health include housing and the living environment, health services and disability.

Socioeconomic position

In general, every step up the socioeconomic ladder is accompanied by a benefit for health (see Health across socioeconomic groups). The relationship is two-way—poor health can be both a product of, and contribute to, lower socioeconomic position.

Socioeconomic position is often described through indicators such as educational attainment, income or level of occupation.

  • In 2019, 65% of people aged 25–64 held a non-school qualification at Certificate III level or above, an increase of 17 percentage points since 2004 (ABS 2019a).
  • Around 10.5% of the population lived in low income households (defined as less than half the median equivalised household income) in 2017–18. This rate has fluctuated between 9.3% and 13.6% since 2003–04 (AIHW 2018; ABS 2019c) (Figure 1).
  • Among major occupation groups, Managers had the highest average weekly total cash earnings in 2018 ($2,425), and Sales workers, the lowest ($736) (ABS 2019b).
     

This Tableau dashboard shows recent trends in 3 key social determinants of health—education, unemployment and income.

In 2019, 65% of people aged 25–64 held a non-school qualification at Certificate III level or above, an increase of 17 percentage points since 2004.

Data are also available for the Proportion of families with children under 15 where no person in the family aged 15 over (including dependents) were employed, and for the Proportion of people living in households with an equivalised disposable household income less than 50% of the national median. 

Early childhood

The foundations of adult health are laid in-utero and during the early childhood period. The different domains of early childhood development—physical, social/emotional and language/cognition—strongly influence school success, economic participation, social citizenship and health.

  • In 2017, almost 4 in 5 children aged 0–2 (79%, or 738,000) were read to or told stories by a parent regularly (3 or more days in the previous week). One in 6 children (16%) were not read to or told stories at all. Parents living in highest socioeconomic areas (85%) were more likely to read or tell stories to their children than those living in lowest socioeconomic areas (70%) (AIHW 2019a).
  • Between 2009 and 2018, the proportion of children entering school who were developmentally vulnerable on 1 or more Australian Early Development Census (AEDC) domains decreased slightly from 24% to 22%. In 2018, children in the lowest socioeconomic group (32%) were more vulnerable than children in the highest socioeconomic group (15%) (AIHW 2019a). See Transition to primary school.
  • One in 10 (10%) children aged 4–12 scored in the ‘of concern’ range on the Strengths and Difficulties Questionnaire measuring social and emotional wellbeing in 2013–14, indicating substantial risk of clinically significant problems in their home, school and community environments (AIHW 2019a).

Family relationships

An individual’s family can influence physical and mental health through providing access to services, products and activities, and through creating a safe and supportive emotional and learning environment.

As with other health determinants, the effects follow a continuum from large potential benefit in positively functioning and supportive families, to potential disadvantage in families with abuse or neglect.

  • 87% of all families with children aged 10–11 rated their family cohesion as good, very good or excellent in 2014–15 (89% for couple families, 76% for one-parent families) (AIHW 2019b).
  • Child abuse and neglect increases the risk of anxiety disorders, depressive disorders and suicide or self-inflicted injuries. When quantified as a risk factor for the burden of disease, the largest relative impacts in 2015 were among young adults (15–24 years; 8.0% of disease burden for females and 5.1% for males) and early working years (25–44 years; 6.5% for females and 4.7% for males) (AIHW 2019c).
  • In 2016, 1 in 6 women (17% or 1.6 million) and 1 in 16 men (6.1% or 548,000) had experienced physical or sexual violence by a current or previous partner since the age of 15 (AIHW 2019d). See Family, domestic and sexual violence and Heath impacts of family, domestic and sexual violence.

Social support and exclusion

Social connectedness and the degree to which individuals form close bonds with others outside the family has been linked in some studies to lower morbidity and increased life expectancy. Strong social networks may benefit physical and mental health, through practical and emotional help and support, and through networks that help people find work or cope with economic and material hardship.

Social exclusion is a term that describes social disadvantage and lack of resources, opportunity, participation and skills which are essential for full participation in society (see Glossary). Social exclusion through discrimination or stigmatisation can cause psychological damage and harm health through long-term stress and anxiety. Poor health can also lead to social exclusion. See Social isolation and loneliness.

  • An estimated 1 in 10 (9.5%, or around 1.8 million) Australians aged 15 and over reported lacking social support in 2016 (AIHW 2019g).
  • In 2014, most people aged 18 and over (95%) reported being able to get support in times of crisis from people living outside the household, a similar prevalence to that in 2002 (94%) (AIHW 2019b).
  • Almost 1 in 4 Australians (24%, or 4.8 million people) experienced some degree of social exclusion in 2017, with 5.6% (1.1 million) experiencing deep social exclusion and 1.2% (240,000) very deep social exclusion (Brotherhood of St Laurence & MIAESR 2019). The prevalence of deep social exclusion has remained relatively steady since 2006 (Productivity Commission 2018).
  • 52% of Australians who had a long-term health condition or disability experienced some level of exclusion in 2017, with 16% experiencing deep social exclusion (Brotherhood of St Laurence & MIAESR 2019).

Employment and work

The psychosocial stress caused by unemployment has a strong impact on physical and mental health and wellbeing. Once employed, participating in quality work helps to protect health, instilling self-esteem and a positive sense of identity, while providing the opportunity for social interaction and personal development.

  • The proportion of the Australian population aged 15–64 who are employed (employment-to-population ratio) has increased over the last 15 years, from a low of 69.9% in February 2004 to a current high of 74.6% in January 2020. Over the same period, the unemployment rate fluctuated between 4.0% (February 2008) and 6.5% (October 2014), with a rate of 5.4% in January 2020 (ABS 2020).
  • In June 2017, there were 1.4 million jobless families in Australia (21% of all families)—a similar figure to that in June 2012 (20%)—and around 339,000 jobless families had dependants (11% of all families with dependants) (ABS 2017b).
  • In November 2019, 1 in 11 (8.9%) employed people aged 15–64 were underemployed (not working the hours they would like to, and available to work)—7.0% and 10.9% of the male and female labour force, respectively (ABS 2020).

See Employment trends and The experience of employment.

Housing and homelessness

Access to appropriate, affordable and secure housing can limit the physical and mental health risks presented by factors such as homelessness and overcrowding.

Evidence also supports a direct association between poor-quality housing and poor physical and mental health (Baker et al. 2016). Young people, Aboriginal and Torres Strait Islander people, people with long-term health conditions or disability, people living in low income housing, or people who are unemployed or underemployed are at greater risk of living in poor-quality housing.

  • More than 116,000 men, women and children, or 50 per 10,000 population, were estimated to be homeless on the night of the 2016 Census of Population and Housing, an increase of 10% from 45 per 10,000 population in 2006 (Figure 2) (ABS 2018). See Homelessness and homelessness services and Health of people experiencing homelessness.
  • 43% of low income households were in rental stress in 2017–18, spending more than 30% of their gross income on housing costs. In 2007–08, 35% of low income households were in rental stress (AIHW 2019e). See Housing affordability.
  • Nearly one-quarter (24%) of renters had windows or doors that did not close properly and 21% of renters had experienced leaks or flooding in 2016 (AIHW 2019e).
  • In 2018, overcrowding in social housing, based on those households needing 1 or more extra bedrooms, was 4.9%. Overcrowding was higher for Indigenous housing at 14% (AIHW 2019f). See Indigenous housing.
     

This chart shows that the rate of homelessness has changed from 50.8 per 10,000 population in 2001, to 45.2 per 10,000 population in 2006, 47.6 per 10,000 in 2011 and 49.8 per 100,000 population in 2016. Most of the increase in homelessness between 2006 and 2016 occurred in persons living in ‘severely’ crowded dwellings, which increased from 15.9 per 100,000 population in 2006 to 21.8 per 100,000 population in 2016.

Monitoring social determinants of health

The AIHW has prioritised continuing monitoring of social determinants and the distribution of health across social groups. It investigates, where possible, which factors contribute to observed inequalities.

There is need for more research to assess the effects of the social determinants of health by following individual experiences over time and across generations. Linking health and welfare data has the potential to provide a broader understanding of the associations between social determinants and health, the experience of population groups, and better evidence for causal pathways to good health.

Where do I go for more information?

For more information on social determinants of health, see:

References

ABS (Australian Bureau of Statistics) 2017a. Labour force, Australia: labour force status and other characteristics of families, June 2016. ABS cat. no. 6224.0.55.001. Canberra: ABS

ABS 2017b. Labour force, Australia: labour force status and other characteristics of families, June 2017. ABS cat. no. 6224.0.55.001. Canberra: ABS.

ABS 2018. Census of Population and Housing: estimating homelessness, 2016. ABS cat. no. 2049.0. Canberra: ABS.

ABS 2019a. Education and work, Australia, May 2019. ABS cat. no. 6227.0. Canberra: ABS.

ABS 2019b. Employee earnings and hours, Australia, May 2018. ABS cat. no. 6306.0. Canberra: ABS.

ABS 2019c. Household income and wealth, Australia, 2017–18. Customised report. Canberra: ABS.

ABS 2020. Labour force, Australia, Jan 2020. ABS cat. no. 6202.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2018. Indicators of Australia’s health: proportion of people with low income. Australia’s health 2018. Cat. no. AUS 221. Canberra: AIHW.

AIHW 2019a. Australia’s children. Cat. no. CWS 69. Canberra: AIHW.

AIHW 2019b. Australia’s welfare indicators. Canberra: AIHW. Viewed 09 January 2020.

AIHW 2019c. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2019d. Family, domestic and sexual violence. Canberra: AIHW. Viewed 09 January 2020.

AIHW 2019e. Housing affordability. Canberra: AIHW. Viewed 09 January 2020.

AIHW 2019f. National Social Housing Survey 2018: key results. Cat. no. HOU 311. Canberra: AIHW.

AIHW 2019g. Social isolation and loneliness. Canberra: AIHW. Viewed 09 January 2020.

Baker E, Lester LH, Bentley R & Beer A 2016. Poor housing quality: prevalence and health effects. Journal of Prevention & Intervention in the Community 44:219–32.

Brotherhood of St Laurence & MIAESR (Melbourne Institute of Applied Economic and Social Research) 2019. Social exclusion monitor. Melbourne: Brotherhood of St Laurence.

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: World Health Organization.

Productivity Commission 2018. Rising inequality? A stocktake of the evidence. Productivity Commission research paper. Canberra: Productivity Commission.

Wilkinson R & Marmot M eds. 2003. The social determinants of health: the solid facts, 2nd edn. Copenhagen: World Health Organization Europe.