Frequently Asked Questions
- What is health equity?
- What are social determinants of health?
- Why is addressing the role of social determinants of health important?
Health equity can be defined in several ways. One commonly used definition of health equity is when all people have “the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance'”.1 The U.S. Department of Health and Human Services defines health equity as attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.2 Achieving health equity, eliminating disparities, and improving the health of all groups is an overarching goal for Healthy People 2020 and a top priority for the Centers for Disease Control and Prevention (CDC).3
Health is influenced by many factors, which may generally be organized into five broad categories known as determinants of health: genetics, behavior, environmental and physical influences, medical care and social factors. These five categories are interconnected.
The fifth category (social determinants of health) encompasses economic and social conditions that influence the health of people and communities.4 These conditions are shaped by socioeconomic position, which is the amount of money, power, and resources that people have, all of which are influenced by socioeconomic and political factors (e.g., policies, culture, and societal values).5,6 An individual’s socioeconomic position can be shaped by various factors such as their education, occupation, or income. All of these factors (social determinants) impact the health and well-being of people and the communities they interact with.
Several factors related to health outcomes are listed below.
- How a person develops during the first few years of life (early childhood development)
- How much education a person obtains and the quality of that education
- Being able to get and keep a job
- What kind of work a person does
- Having food or being able to get food (food security)
- Having access to health services and the quality of those services
- Living conditions such as housing status, public safety, clean water and pollution
- How much money a person earns (individual income and household income)
- Social norms and attitudes (discrimination, racism and distrust of government)
- Residential segregation (physical separation of races/ethnicities into different neighborhoods)
- Social support
- Language and literacy
- Culture (general customs and beliefs of a particular group of people)
- Access to mass media and emerging technologies (cell phones, internet, and social media)
All of these factors are influenced by social circumstances. Of course, many of the factors in this list are also influenced by the other four determinants of health.
Addressing social determinants of health is a primary approach to achieving health equity. Health equity is “when everyone has the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance’”.7 Health equity has also been defined as “the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages—that is, different positions in a social hierarchy”.8 Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities. The Centers for Disease Control and Prevention (CDC) is committed to achieving improvements in people’s lives by reducing health inequities. Health organizations, institutions, and education programs are encouraged to look beyond behavioral factors and address underlying factors related to social determinants of health.
A growing body of research highlights the importance of upstream factors that influence health and the need for policy interventions to address those factors—in addition to clinical approaches and interventions aimed at modifying behavior.9
The Centers for Disease Control and Prevention (CDC) is committed to achieving improvements in people’s lives by reducing health inequities. Health organizations, institutions, and education programs are encouraged to look beyond behavioral factors and address underlying factors related to social determinants of health.
The World Health Organization (WHO)external icon created the Commission on Social Determinants of Healthexternal icon to address social determinants of health.4 The Commission uses the following three principles to guide its work in eliminating health inequities for local communities and nations and throughout the world:
- Improve the conditions of daily life—the circumstances in which people are born, grow, live, work, and age.
- Tackle the inequitable distribution of power, money, and resources—the structural drivers of those conditions of daily life—globally, nationally, and locally.
- Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.4
The commission created the conceptual framework below that describes relationships among individual and structural variables. The framework represents relationships among variables that are based on scientific studies or substantial evidence. The framework provides a point from which researchers can take action, such as creating targeted interventions, on social determinants of health.
More information is available from a variety of sources, including the following publications and web sites.
- World Health Organizationexternal icon
- U.S. Department of Health and Human Services Office of Minority Healthexternal icon
- Office of Minority Health’s National Partnership for Action to End Health Disparitiesexternal icon
- National Association of County and City Health Officials (NACCHO) Health Equity and Social Justiceexternal icon
- The Robert Wood Johnson Foundation (RWJF)external icon
- Healthy People 2020external icon
- Equity, social determinants and public health programmespdf iconexternal icon. Editors Erik Blas and Anand Sivasankara Kurup. 2010, World Health Organization: Geneva.
- Commission on Social Determinants of Health (CSDH), 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 Healthpdf iconexternal icon. 2008, World Health Organization: Geneva.
- Hillemeier, M., Lynch, J., Harper, S., Casper, M., Data Set Directory of Social Determinants of Health at the Local Levelpdf icon. 2004, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services: Atlanta.
- Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
- Hofrichter, R., Bhatia, R. (Eds.) Tackling Health Inequities through Public Health Practice: Theory to Action. 2010, Oxford University Press.
- Raphael, D., ed. Social determinants of health: Canadian perspectives. 2004, Canadian Scholars’ Press Toronto.
- Marmot, M.G. and R.G. Wilkinson, Social determinants of health. 2nd ed. 2006, Oxford ; New York: Oxford University Press. x, 366 p.
You can e-mail the Office of Health Equity at OHEinquiries@cdc.gov.
- Braveman, P.A., Monitoring equity in health and healthcare: a conceptual framework. Journal of health, population, and nutrition, 2003. 21(3): p. 181.
- U.S. Department of Health and Human Services, Glossary of Termsexternal icon. 2018.
- CDC, Attaining Health Equity; ODPHP, Disparitiesexternal icon.
- Commission on Social Determinants of Health (CSDH), 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. 2008, World Health Organization: Geneva.
- U.S. Department of Health and Human Services. Healthy People 2020external icon. Social Determinants of Health.
- Commission on Social Determinants of Health (CSDH). A Conceptual Framework for Action on the Social Determinants of Health. Discussion Paper for the Commission on Social Determinants of Health DRAFT. 2007, World Health Organization: Geneva.
- Brennan Ramirez LK, B.E., Metzler M., Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health, Centers for Disease Control and Prevention, Editor. 2008, Department of Health and Human Services: Atlanta, GA.
- Braveman, P. and S. Gruskin, Defining equity in health. Journal of Epidemiology and Community Health, 2003. 57(4): p. 254-258.
- Health Policy Brief: “The Relative Contribution of Multiple Determinants to Health Outcomes,” Health Affairs, August 21, 2014.