Social Determinants of Health: the Solid Facts - Second Edition

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Reference Materials. The Social Gradient pdf. Building Healthy Communities pdf.

AAHC | Social Determinants of Health Initiative | Resources

Built Environment. In the literature reviewed here, health equity was predominantly used when discussing the structural or societal-level changes needed to improve health. Studies also referred to health equity when making ethical claims e. Quantitative content analysis of all sources revealed the frequency of use of the above terms. Equity terms equity, inequity, inequities were used in Other papers that frequently used the term health equity included a sociological commentary on health equity,[ 69 ] an Alberta Health Services publication on social environments and health,[ 93 ] and a paper produced by a private organization regarding the SDOH agenda in Canada.

Equality terms were used most frequently in two articles by Graham, in her writings on the SDOH in the context of UK government policy. Related to health equity and inequity are the terms equality and inequality. Equality and inequality also refer to differences in health as present or absent, but do not carry the same moral undertones as equity and inequity. As shown in Table 2 , the terms in equity and in equality appeared with similar frequency. This may simply reflect that the terms are used interchangeably. Such strategic use of terms may be especially true for studies published by authors within organizations where there may be real or perceived consequences of associating SDOH-related differences as unfair i.

We expand on this third reason below. Another key concept we observed as prominent in the literature reviewed is the social gradient in health, which refers to the stepwise relationship between health and social position. The social gradient in health appeared in various forms in the literature that we reviewed. For example, some articles attempted to quantify the social gradient e.

To further interrogate the use of the social gradient in health in the literature, we conducted a quantitative content analysis of the social gradient in health and related terms. These findings suggest the wide use of this concept. While health equity was a common element of the literature we reviewed, e.

To describe the different conceptualizations, we draw on the concepts of upstream and downstream as well as the work of Graham [ ] and Whitehead On the ladder of intervention, downstream interventions tend to occupy lower rungs e. Because the social gradient in health pertains to entire populations, it highlights the need for interventions that will tackle the distribution of health determinants.

Much of the literature that we reviewed supported an upstream approach to health equity by reducing gradients and promoting healthy macro-level policies. A major emphasis among articles supporting a gradient approach was the recognition that a collaborative and integrative approach would be necessary. Some articles called for greater collaboration between disciplines, departments, or sectors e. A good illustration of the gradient and a healthy macro-policy approach to acting on the SDOH is Brennenstuhl et al.

While upstream, gradient, and healthy macro-social policy approaches seem desirable for their ability to address the root causes of health inequities and act on multiple SDOH across sectors,[ 17 ] they have also been subject to criticism. Popay et al. In other articles, action on the SDOH was understood with reference to specific subgroups facing social disadvantage. In some cases, as noted by Frohlich et al.

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The notion of proportionate universalism has been put forth to recognize the challenges posed by population-level interventions for certain groups. While proportionate universalism was not prominent in our target literature which makes sense considering its recency , we found that targeted and downstream approaches to health equity and the SDOH were prevalent in the literature. In many cases this reflected the professional scope of the authors. The Canadian Nurses Association, for example, put forth an idea for how individual nursing practice could act on the SDOH, by asking patients certain questions e.

A similar trend towards targeted and downstream approaches to action on the SDOH was found in literature reporting on the public health workforce McIntyre et al. An emphasis on downstream approaches to remedying health inequities may also apparent in academic scholarship. Raphael and Bryant have asserted that, aside from a handful of critical scholars, academics predominantly do not write about action on the SDOH in ways that focus on upstream, macrosocial factors in their research.

In summary, in the literature reviewed we identified that though health equity is a common, binding concept in the SDOH, there are different ways in its conceptualization. These differences have implications for approaches to action, which range from a more upstream, structural approach that considers the social gradient as well as the determinants and processes that distribute resources across the population, to a more downstream, community or individual-level approach that focuses on social or behavioural factors operating within specific groups sometimes, but importantly not always, these social and behavioral factors are considered discretely or in isolation.

The different approaches do not appear to have been strongly reconciled. The main limitations of this scoping review are threefold. First, our internet Google search for SDOH literature was conducted from a Canadian Internet Protocol address, which may have returned results specific to our geographic setting Canada and thus inflated the estimates of Canadian content.

Future work may consider comparing how grey literature on the SDOH in other countries differs from that produced in Canada. Another facet of this limitation is that our search for grey literature utilized Canadian databases i.

Introduction to the Cardi-OH SDOH Glossary

However, the academic literature revealed similar proportions as found for grey literature i. As well, despite this limitation, our inclusion of grey literature still adds novelty and merit to existing literature reviews on the SDOH. To the extent that other countries or disciplines discuss the concept of SDOH using different language e. Furthermore, we attempted to address this limitation through our iterative and nuanced approach to the search i. Visual representation of approach to inclusion criteria , which we argued was essential for this literature because of its somewhat diffuse and jargonized nature.

In this scoping review, we set out to take stock of and synthesize SDOH literature in the contemporary context of population and public health. Our main conclusions are threefold. First, most of the literature has been published in the last decade — , in academic settings, with the intent of reaching policy makers. Just over half of the literature came from Canadian sources. Second, the SDOH were communicated in three ways as a list, conceptual model or framework, or narrative or story.

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Each form of communication appears to have met the needs of different authors and audiences. To some extent, these forms of communicating the SDOH may have aligned with the epistemologies of objectivism, constructivism, and subjectivism. Third, we identified health equity as a binding concept and overarching theme of the SDOH.

In part, this was observed in the literature through the frequent use of key terms related to health equity, such as the social gradient in health. We also found that different ways of achieving health equity, through action on the SDOH, were conceptualized as more upstream or downstream in nature. Overall, we found that the current literature did not unanimously adopt the language of health equity when presenting and discussing the SDOH.

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We suggest that intentional articulation of the SDOH in this way by authors may help unify the message that the SDOH are fundamentally about health equity. This review has identified a literature gap for articles published from countries outside the global north. Very few authors were situated in developing or poor countries, which limits our understanding of the SDOH at a global level and the transferability of our findings. This is especially important considering that recent work by the WHO has called for the global redistribution of resources to achieve health equity worldwide.

Conceptualization: KL LM. Formal analysis: KL LM. Investigation: KL. Methodology: KL LM. Project administration: KL. Supervision: LM. Validation: KL LM.

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Visualization: KL LM. Writing — original draft: KL. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.

Abstract Background In recent decades, the social determinants of health SDOH has gained increasing prominence as a foundational concept for population and public health in academic literature and policy documents, internationally. Findings Our synthesis of articles showed wide variation by study setting, target audience, and geographic scope, with most articles published in an academic setting, by Canadian authors, for policy-maker audiences. Introduction Overview In recent decades, the social determinants of health SDOH , that is the social, economic, and political conditions that influence the health of individuals and populations, has gained increasing prominence as a foundational concept to the field of population and public health PPH.

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