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A visualization of determinants of health portraying the various layers of social, economic, political, cultural, and environmental factors, sourced from Dahlgren and Whitehead (1991) (3). 



Through the work of researchers such as Sir Michael Marmot, we now understand that good health does not lie solely with medical interventions but also with living conditions and personal choices (4, 5). Determinants of health are lifestyle-based properties affected by broader social, economic, and political forces that influence quality of personal health. These attributes include but are not limited to education level, employment, income level and distribution, housing, childhood development, food security and nutrition, race, gender, and stress. Such factors have been shown to have marked associations with risks for different illnesses, life expectancy, and life-time morbidity. In recent decades, increasing health disparities in developed countries and between developing and developed countries have been associated with these social factors. While public health workers and policymakers seek to reduce this divide, they face challenges in designing and implementing programs that are comprehensive enough to address issues that have complex, long-term, causal relationships with specific disease pathways. However, both the motivation and action to develop effective research and intervention methods continue to grow in this field of public health (1).



Documents and publications



Related links

Areas of Work

  • Utilizing health promotion and health education approaches to promote informed, comprehensive, upstream participatory decision-making and action
  • Determining associations between social factors and health status  
  • Creating scientific methodologies for examining social factors in health
  • Reducing health disparities and promoting equal access to health care
  • Applying social theory to health and illness
  • Measuring and monitoring social factors
  • Human Security
  • Violence
  • Urban Health and Healthy Settings
  • Worker's Health 


The below figures demonstrate that improved social conditions and better health status often have a positive, step-wise, incremental gradient association (2). Click on the figure to enlarge:

Click to enlarge: Income and education disparities in child health by (a) infant mortality, (b) health status, (c) activity limitation, and (d) sedentary behavior: United States, 1999-2005

Click to enlarge: Income and eudcation disparities in adult health by (a) life expectancy, (b) health status, (c) heart disease, and (d) diabetes: United States, 1988-2007


  1. Braveman PA, Cubbin C, Egerter S, Williams DR. 2011. The social determinants of health: coming of age. Annu. Rev. Public Health 32:3.1-3.18
  2. Braveman PA, Cubbin C, Egerter S, Williams DR, Pamuk E. 2010. Socioeconomic disparities in health in the United States: what the patterns tell us. Am. J. Public Health 14:20–35
  3. Dahlgren G, Whitehead M. 1991. Policies and strategies to promote social equity in health: background document to WHO – strategy paper for Europe. Institute for Future Studies: Stockholm
  4. Marmot M. 2005. Social determinants of health inequalities. Lancet 365: 1099-1104
  5. Marmot MG, Davey Smith G, Stansfeld S, Patel C, North F, et al. 1991. Health inequalities among British civil servants: the Whitehall II study. Lancet 337:1387–93


Last Updated on Tuesday, 15 January 2013 16:47

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