Social Determinants of Health
DESoziale Determinanten der Gesundheit
Social determinants of health (SDoH) are the non-medical conditions in which people are born, grow, live, work and age — income, education, employment quality, housing, neighbourhood, social network, early-childhood development and access to services — that shape health outcomes and inequities. The WHO Commission on Social Determinants of Health (CSDH, 2008, chaired by Michael Marmot) framed inequities in power, money and resources as the 'causes of the causes' of disease. The WHO estimates SDoH account for 30–55% of health outcomes, exceeding the contribution of clinical care. In England, the Marmot Review 10 Years On (2020) documented stalled life expectancy and a widening gradient: between 2016-18, men in the most deprived decile lived ~9.5 years (women ~7.7 years) less than those in the least deprived, and the gap in healthy life expectancy at birth was ~19 years for both sexes (ONS). In Germany, the GISD-based analysis by Michalski et al. (2022) reports a life-expectancy gap of ~6.0 years for men and ~3.2 years for women between districts in the lowest and highest deprivation deciles (2015-17 data).
Sources
- Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. *The Lancet*doi:10.1016/S0140-6736(08)61690-6
- World Health Organization 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. *WHO*
- Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. (2020). Health Equity in England: The Marmot Review 10 Years On. *Institute of Health Equity / The Health Foundation*
- Michalski N, Reis M, Tetzlaff F, et al.. (2022). Regional health differences – developing a socioeconomic deprivation index for Germany (GISD). *Journal of Health Monitoring (RKI)*