Taking stock of the social determinants of health: A scoping review

Abstract

BackgroundIn 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. However, alongside its widespread dissemination, and in light of multiple conceptual models, lists, and frameworks, some dilution and confusion is apparent. This scoping review represents an attempt to take stock of SDOH literature in the context of contemporary population and public health.MethodsWe conducted a scoping review to synthesize and map SDOH literature, informed by the methods of Arksey and O’Malley (2005). We searched 5 academic and 3 grey literature databases for “social determinants of health” and “population health” or “public health” or “health promotion,” published 2004–2014. We also conducted a search on “inequity” or “inequality” or “disparity” or “social gradient” and “Canad*” to ensure that we captured articles where this language was used to discuss the SDOH. We included articles that discussed SDOH in depth, either explicitly or in implicit but nuanced ways. We hand-searched reference lists to further identify relevant articles.FindingsOur synthesis of 108 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. SDOH were communicated by authors as a list, model, or story; each with strengths and weaknesses. Thematic analysis identified one theme: health equity as an overarching and binding concept to the SDOH. Health equity was understood in different ways with implications for action on the SDOH.ConclusionsAmong the vast SDOH literature, there is a need to identify and clearly articulate the essence and implications of the SDOH concept. We recommend that authors be intentional in their efforts to present and discuss SDOH to ensure that they speak to its foundational concept of health equity.

Neighborhood Social and Built Environment and Disparities in the Risk of Hypertension: A Cross-Sectional Study

“…Social determinants of health played an important role in addressing the sustainable development goals targets to promote health and well-being and to reduce disparity [ 3 ]. The social environment, comprising personal and societal relationships, institutions, cultures, and physical surroundings—all the aspects and products of human activity and interaction—is insufficiently researched in relation to health.…”

How should we act on the social determinants of health?

“…The authors also suggested a "social determination" approach, with an emphasis on the underlying social processes and structural forces that drive variations in the risk factors that affect health. 7 Greater recognition of the social determinants of health represents a welcome shift away from a focus on individual-level influences on health -which affords primacy to genetic and clinical factors -to a more complex viewpoint that includes societal, community and structural factors. 6 Consideration of these wider structural factors provides a much-needed opportunity to focus on the upstream causes of health variations (i.e., the causes of the causes), which supports preventing disease and enabling good health for all.…”

“…However, a 2017 scoping review identified a paucity of publications on the social determinants of health from countries outside the Global North, thus limiting a global perspective and the application of the concept to the developing world. 7 Spiegel and colleagues 8 dissected the language of the social determinants of health, noting the dominance of a reductionist approach that focuses on risk factors related to individual living and working conditions or perhaps, at best, community influences, rather than bringing attention to structural and political processes, and…”

Recent quantitative research on determinants of health in high income countries: A scoping review

“…In some cases, the impact of one or more interventions is at the core of the review [3][4][5][6][7], while in others it is the relationship between health and just one particular predictor, e.g., income inequality, access to healthcare, government mechanisms [8][9][10][11][12][13]. Some relatively recent reviews on the subject of social determinants of health [4][5][6][14][15][16][17] have considered a number of indicators potentially influencing health as opposed to a single one. One review defines "social determinants" as "the social, economic, and political conditions that influence the health of individuals and populations" [17] while another refers even more broadly to "the factors apart from medical care" [15].…”

“…Some relatively recent reviews on the subject of social determinants of health [4][5][6][14][15][16][17] have considered a number of indicators potentially influencing health as opposed to a single one. One review defines "social determinants" as "the social, economic, and political conditions that influence the health of individuals and populations" [17] while another refers even more broadly to "the factors apart from medical care" [15].…”