Cebu City - The Social Determinants of Health (SDH) all influence and interact with one another to affect health and well-being. To understand how they work with each other, there are several frameworks being proposed.  The most common is the one developed by the World Health Organization (WHO) called the Commission of Social Determinants.

According to WHO, there are two, broad types of health determinants that influence health and can lead to health inequities. These are Structural Determinants and Intermediary Determinants.

Structural Determinants refer to the Socioeconomic and Political Context in which a person is born and lives.

These include Governance, meaning how society organizes itself to make and implement decisions; Policies, meaning the economic, social, and public policies; and Values, meaning the social and cultural values that communities place on health. These factors can determine and lead to the unequal distribution of material and monetary resources which shapes a person’s socioeconomic position.

Socioeconomic Position describes a person’s place in society which can reflect their exposure, vulnerability, and outcomes that have an impact on their health. The Socioeconomic Position is determined by a number of factors such as Education, Occupation, Income, Gender, Race/Ethnicity, and Social Class. The Socioeconomic Position in turn affects the Intermediary Determinants of Health.

The Intermediary Determinants of Health include Material Circumstances e.g. quality housing, financial means to buy healthy food, clothing, or other requirements for healthy living, and work environment. Next would be Psychosocial Circumstances e.g. stressful living circumstances, relationships, and social support. Lastly, there are Behavioral and Biological Factors.

In addition to these, Health Systems have an impact on the type and quality of health care available to people. It also determines how easy it is for people to access health services and receive the health care they need.

Social Cohesion and Social Capital are factors that bridge the Structural and Intermediary Determinants. They describe the willingness of people living in a community to make sacrifices and cooperate with each other for a wider benefit.

Intermediary Determinants influence health and health inequities. It is also important to know the links between these different factors are not always linear but are complex and can go in both directions. For example, poor income and education can impact poor health. In turn, poor health can limit opportunities for people to participate in the workforce or receive an education. Also, if a population is affected by a lot of diseases, it can have a broader impact on the socio-economic and political context.

Now comes the big question. How can we change these determinants? Addressing the social determinants of health is not an easy task. It involves identifying the Structural and Intermediary Determinants of Health and taking appropriate actions to improve them. To do this requires actions across all sectors of society and at all levels including local, national, and international. The actions will depend on the existing socio-economic and political context. Resources that are available and commitment to action.

So, the next time you think about a health issue, consider not only who they are and what they do but also the conditions in which they are born, grow, live work, and age. Because if we understand and act on them, we can build a healthier world for everyone and the future generations that will come after. // ND II Mary Carmeli C. Garrovillo, RND