Public health

This article has been written by Sarita Sah pursuing a Remote freelancing and profile building program from Skill Arbitrage.

This article has been edited and published by Shashwat Kaushik.


For many years, the main agenda of the healthcare system was to treat disease after it became apparent. A more complex picture, however, is painted by our growing understanding of the Social Determinants of Health (SDOH), which shows that factors other than medical care have a major impact on both individual and community health outcomes.[1] Social, cultural, and environmental factors are all included in SDOH and influence people’s places of birth, residence, education, employment, and recreation. These factors, which include social support networks, housing, education, and income, can have a significant impact on health risks, healthcare access, and general well-being.

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Research constantly shows a strong correlation between SDOH and health outcomes. Poverty and low levels of education are associated with increased rates of chronic illnesses, shorter life spans, and increased susceptibility to health hazards. For example, children from low-income families are more likely to experience developmental delays, obesity, and mental health challenges. Additionally, individuals residing in unsafe neighbourhoods with limited access to healthy food and quality healthcare face increased risks for various health problems.

Social determinants of health

Economic factors

The most important and vital factor is income inequality, which has a significant impact on health outcomes. Individuals with lower incomes often face food insecurity, inadequate housing, and limited access to quality healthcare, contributing to higher rates of chronic diseases and poorer overall health. The other side is unemployment and underemployment, which lead to stress, financial insecurity, and limited access to health insurance, further exacerbating health disparities.

Educational factors

Education level significantly impacts health outcomes. Individuals with higher education levels tend to have better health literacy, healthier lifestyles, and access to preventive care, leading to better health outcomes. It has an indirect effect on economic factors and the lifestyle of an individual.

Unequal access to quality education across different socioeconomic groups contributes to health disparities. Children from disadvantaged backgrounds may lack access to healthy school meals, physical activity opportunities, and comprehensive health education, putting them at a disadvantage for future health.

Social and community

Moral values of individual and mental peace are very essential for good health. Today, living in a society with high crime rates and limited access to green spaces can lead to chronic stress, anxiety, and a fear of participating in outdoor activities, negatively impacting physical and mental health. To overcome the above-mentioned problem, a social support network is the only solution. Strong social support networks provide individuals with emotional support, resources, and a sense of belonging, contributing to better mental and physical health outcomes. Conversely, social isolation and a lack of support can increase vulnerability to health problems.

Interplay of social determinants and health

The statistical study from various healthcare journals and websites that have significant data shows the consequences and factors responsible for the health concerns. A few insights from some publications show concern, which includes social determinants.

  • A 2020 study published in Journal of American Medical Association found that individuals living in the lowest income quintile had a life expectancy 4.8 years shorter than those in the highest income quintile.
  • A 2021 study in the Journal of Public Health found that adults with less than a high school education were twice as likely to report poor health compared to those with a college degree.

In India, the healthcare system shows a complex picture. The public healthcare system here, offers subsidised care to a large population, but access and quality remain uneven, especially in rural areas. Private healthcare flourishes, catering to those who can afford it, widening the access gap. This scenario highlights the urgent need to address not just healthcare access but also the underlying factors that contribute to health disparities.

Identifying vulnerable populations

A confined section of the population all over the world is disproportionately affected by negative SDOH, including low-income individuals, racial and ethnic minorities, immigrants, and individuals with disabilities. The vicious cycle of poor health limits education and employment opportunities, perpetuates poverty and widens the health gap. Identifying these vulnerable populations is very important for targeting interventions and policy changes.

Crucial role of healthcare

Healthcare systems all over the world have a vital role to play in addressing SDOH. Here are some key strategies:

  • Integrating SDOH into healthcare practices: Screening patients for social risks during routine care allows for early identification of needs and connections to relevant community resources, such as food banks, housing assistance programmes, or mental health services.
  • Enhancing cultural competence: Culturally competent healthcare providers understand and respect the diverse needs, values, and beliefs of their patients, leading to better communication and trust and, ultimately, improved health outcomes.
  • Implementing community-based healthcare initiatives: Collaborating with community organisations to deliver healthcare services in accessible locations, such as schools or community centres, can improve access to care for underserved populations.

Policy and advocacy

Good policies always play a crucial role in addressing SDOH at a systemic level. Healthcare professionals and institutions together can advocate for policies that promote health equity, such as universal access to quality education, improved sanitation infrastructure, and social protection programmes. This systemic approach can create a more enabling environment for good health.

Universal access to quality education:

  • Education is a fundamental human right and a key determinant of health outcomes.
  • Good policies should ensure equitable access to quality education for all individuals, regardless of their socioeconomic status or geographic location.
  • Investing in education can break the cycle of poverty and improve health outcomes by providing individuals with the knowledge, skills, and resources they need to make healthy choices and navigate complex health systems.

Improved sanitation infrastructure:

  • Access to clean water and adequate sanitation is essential for preventing the spread of diseases and promoting good health.
  • Good policies should prioritise investments in improving sanitation infrastructure, particularly in underserved communities.
  • Ensuring access to safe water and sanitation can significantly reduce the burden of waterborne diseases and improve overall health outcomes.

Social protection programmes:

  • Social protection programmes play a vital role in reducing poverty and ensuring that individuals have access to basic necessities, such as food, housing, and healthcare.
  • Good policies should strengthen social protection systems and expand coverage to vulnerable populations.
  • Social protection programmes can help to reduce health disparities and promote social inclusion, ultimately leading to better health outcomes.

Advocacy and collaboration:

  • Healthcare professionals and institutions have a responsibility to advocate for policies that promote health equity.
  • They can work with policymakers, community organisations, and other stakeholders to raise awareness about the importance of addressing SDOH and to advocate for evidence-based policies.
  • Collaboration between healthcare professionals, policymakers, and communities is essential for developing and implementing effective policies that address the SDOH.

Monitoring and evaluation:

  • It is important to monitor and evaluate the impact of policies on health outcomes.
  • Regular monitoring and evaluation can help to identify policy gaps and areas for improvement.
  • By continuously monitoring and evaluating policies, policymakers can ensure that they are effective in improving the health and well-being of individuals and communities.

Challenges and opportunities

There are many challenges in implementing SDOH-focused interventions. Some challenges to focus on are:

  • Lack of awareness and data: Healthcare professionals often lack training in identifying and addressing SDOH. Comprehensive data on SDOH and its impact on health outcomes is scarce.
  • Fragmented healthcare system: Collaboration between different sectors and levels of government is often weak, hindering coordinated efforts.
  • Limited resources and funding: Integrating SDOH interventions requires additional resources, which can be scarce in resource-constrained settings.

Despite these challenges, opportunities do exist:

  • Government partnerships and funding: Collaborations between government and healthcare institutions can leverage resources and expertise for scaling up interventions.
  • Innovative financing models: Social impact bonds and pay-for-performance models can incentivize investments in SDOH interventions based on demonstrated outcomes.
  • Technology and data-driven solutions: Technology can facilitate screening, referrals, and data collection to monitor progress and inform policy decisions. Mobile health platforms and telemedicine can reach remote populations and overcome access barriers.


A very good quote by Dr. Mark Hyman – “What most people don’t realise is that food is not just calories: it’s information. It actually contains messages that communicate with every cell in the body.” It directly shows how we should proceed to work together for a better and healthier life. Now it’s time for our policymakers to work on it. SDOH, through healthcare, is a powerful strategy for achieving health equity. Though challenges exist, the potential benefits are vast. Prioritising SDOH, allocating resources, and fostering an environment that supports sustainable interventions call for coordinated action by stakeholders, legislators, and healthcare professionals. We may advance towards a future where everyone has the chance to realise their full potential in terms of health by adopting this all-encompassing approach.



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