Keeping It Political and Powerful: Defining the Structural Determinants of Health

Abstract

Policy Points The structural determinants of health are 1) the written and unwritten rules that create, maintain, or eliminate durable and hierarchical patterns of advantage among socially constructed groups in the conditions that affect health, and 2) the manifestation of power relations in that people and groups with more power based on current social structures work—implicitly and explicitly—to maintain their advantage by reinforcing or modifying these rules. This theoretically grounded definition of structural determinants can support a shared analysis of the root causes of health inequities and an embrace of public health's role in shifting power relations and engaging politically, especially in its policy work. Shifting the balance of power relations between socially constructed groups differentiates interventions in the structural determinants of health from those in the social determinants of health.

Social and Structural Determinants of Health Associated with COVID-19 Vaccine Hesitancy among Older Adults in the United States

“…This level of association seen in the StrDoHs may be related to the refusal to validate governmental regulations, such as social distancing and institutional conflicts between religion, political affiliation, and science, especially regarding vaccination [78,79]. The variation of hesitancy may also be related to policies intervening on specific social determinants of health predictors and having influence mediated by existing religious practices, norms, and culture [40,44]. Public health organizations can partner with faith-based organizations to conduct health programs and use their "voice" to promote vaccine acceptance.…”

“…Structural determinants of health (StrDoHs) are cultural, political, social, and economic structures that form the distribution of symbolic power, materials, and resources [40]. StrDoHs are the basis of health inequities, and they look at the interplay between sociopolitical factors because they examine the quality of the social determinants of health experienced by people in their neighborhoods and communities [40,41].…”

“…Structural determinants of health (StrDoHs) are cultural, political, social, and economic structures that form the distribution of symbolic power, materials, and resources [40]. StrDoHs are the basis of health inequities, and they look at the interplay between sociopolitical factors because they examine the quality of the social determinants of health experienced by people in their neighborhoods and communities [40,41]. Although religion is considered a social and structural determinant of health, the latter can influence institutional and socioeconomic conditions, such as economic decisions, political parties, policy, racism, colonialism, and admittance to electoral offices [42].…”