Social Determinants and Health: An Introduction

The social development of any individual and society is a lot dependent upon the place where they live. The society in U.S.A is much more developed than say in Africa. However a puzzling aspect of this development is the striking difference between individuals that live in the same kind of environment. One of the case in point for this argument is the difference between the health status of the citizens living in countries of the same region. The infant mortality in Bangladesh is much less than that of India inspite of being so close neighbours. The health outcomes in Sri Lanka are so much better than all the countries of South-Asia. This kind of variation between social indicators is present even within the national boundaries. In India, the state of Kerala tends to enjoy better maternal health and higher educational attainment than the state of Uttar Pradesh. Why do these differences in well being arise among people in different parts of the world, among countries in the same region and among citizens in the same country?

The traditional notion of health essentially rested on the idea that health is merely an absence of disease. This idea was prevalent during the first half of the twentieth century and was widely shared between the doctors and other members of the medical fraternity. This view was based on the assumption that health and disease are observable and objective phenomenon and thus can be measured. Therefore rather than identifying specific features of good health, this view defined health only as absence of any disease, infirmities or any signs and symptoms of it. The major drawback of this approach is that it overlooked the individual as a whole and emphasised only on specific parts of the body.

This approach began to see a change in the later part of the last century. It was recognised that the social surrounding of an individual has an effect on the body functions which leads to either an improvement in the health of an individual or a decline in his health depending on the kind of circumstances that he gets exposed to. People living in disadvantaged conditions tend to compare themselves with better who are better off than them which lead to an increase in the psychological stress they get exposed thus increasing their vulnerability to diseases. Along with social surroundings, economic and political factors also have an effect on health. The economic and political processes influence the distribution of available resources thereby shaping the public infrastructure- transport, health, education, environment, availability of food etc. which in turn has a bearing on the health outcome of the population.

The idea of going beyond a pure bio-medical explanation for health status of individuals and looking at social determinants has provided researchers with tools for explaining the puzzle related to difference in health of individuals and societies who although living in the same country, state or municipal limits have different burden of disease. Various researches conducted around the world have identified factors like Education, Caste/Ethnicity, Religion, Transport etc. which account for the difference that people experience in terms of their health outcomes. These factors are important not only from the purpose of academic interest but are also critical from the perspective of the policy makers. Government agencies at the country level, state level and at local level and other private organisations are increasingly becoming aware of the fact that for health interventions to succeed, a thorough knowledge of the milieu in which people live and work is essential. If interventions are designed to improve the social conditions in which the society functions, then the benefits can be immense in terms of reducing the health inequity.