Promoting Health Equity - A Resource to Help Communities Address ...

How do social determinants
infuence health?
Multiple models describing how social determinants
infuence health outcomes have been proposed. 30–40
Although differences in the models exist, some fairly
consistent elements and pathways have emerged.
The model presented here contains many of these
elements and pathways and focuses on the distribution
of social determinants (see Figure 1.1). As the model
shows, social determinants of health broadly include
both societal conditions and psychosocial factors,
such as opportunities for employment, access to health
care, hopefulness, and freedom from racism. These
determinants can affect individual and community
health directly, through an independent infuence or
an interaction with other determinants, or indirectly,
through their infuence on health-promoting behaviors
by, for example, determining whether a person has
access to healthy food or a safe environment in which
to exercise.
Policies and other interventions infuence the availability
and distribution of these social determinants to different
socialgroups,includingthosedefnedbysocioeconomic
status, race/ethnicity, sexual orientation, sex, disability
status, and geographic location. Principles of social
justice infuence these multiple interactions and the
resulting health outcomes: inequitable distribution of
social determinants contributes to health disparities and
health inequity, whereas equitable distribution of social
determinants contributes to health equity. Appreciation
of how societal conditions, health behaviors, and
access to health care affect health outcomes can
increase understanding about what is needed to move
toward health equity.
Figure 1.1: Pathways from Social Determinants to Health
Figure adapted from Blue Cross and Blue Shield of Minnesota Foundation, http://www.bcbsmnfoundation.org/
objects/Tier_4/mbc2_determinants_charts.pdf and Anderson et al, 2003. 38,39