Determinants of health

Social determinants are the conditions in which people grow, learn, work and participate in society. They affect physical, mental and social health through opportunities, resources and exposure to risks. An explanation must connect a condition to a pathway and a possible health effect. People still make choices, but the choices available are not equal. Several determinants can operate together, so categories are useful organising tools rather than completely separate boxes.

The social gradient describes a stepwise pattern: health tends to improve as social and economic position improves across the population, not only between the poorest and everyone else. Greater control and resources can reduce harmful exposures. Stress, especially persistent stress with inadequate support, can disturb sleep and coping. Early life conditions, including secure relationships, nutrition and safe housing, influence development and later opportunities. Social exclusion means barriers to participation, such as discrimination, which can reduce belonging and access to assistance.

Work can provide purpose and supportive relationships, although unsafe conditions or low control may harm health. Unemployment can remove routine, income and social connection, increasing uncertainty. Social support provides practical help and emotional reassurance. Addiction involves dependence or impaired control and can both arise within difficult social conditions and worsen relationships or financial security; blame does not explain its causes. Food is influenced by availability, affordability and shared eating practices.

Transport connects people to school, employment and services; reliable safe options improve participation. Culture, including language, identity and shared practices, can strengthen belonging. Discrimination and culturally inappropriate services can create barriers; culture itself should not be treated as a defect.

When interpreting a social gradient, describe a population tendency. It does not predict every person's health. Protective relationships and effective services can interrupt pathways from disadvantage to poorer health.