Frequently Asked Questions

Frequently Asked Questions

What do we mean by social determinants of health?

Different models have been developed to interpret how social determinants influence health status and health inequalities. Some of these include, for example, the Dahlgren and Whitehead Model (1991), the Diderichsen and Hallqvist Model (1998) adapted by Diderichsen, the Evans and Whitehead (2001), the Mackenbach Model (1994) and the Marmot and Wilkinson Model (1999). These different approximations are not necessarily mutually exclusive, and the available evidence reveals gaps of uncertainty concerning their relative validity and the links between them. However, the analysis of interventions and policies addressing social determinants of health requires a framework that indicates the origins of health inequities, how inequities relate to social determinants and how various social determinants of health relate to one another.

The social determinants of health refer to both specific features of and pathways by which societal conditions affect health, and which potentially can be altered by informed action. Traditionally, social determinants have been identified as characteristics of the individual, such as a person’s social support network, income or employment status. Populations are not merely collections of individuals. Yet, the causes of ill health are clustered in systematic patterns, and the effects on one individual may depend on the exposure and outcome for other individuals, because the determinants of individual differences regarding characteristics within a population may be different from the determinants of differences between populations.

It is useful to distinguish two kinds of etiological questions. The first seeks the causes of cases, that is, the determinants of individual cases. The second seeks the causes of incidence, that is, it addresses the determinants of population incidence rates. Therefore, when we talk about social determinants, we seek to answer how the causes of cases relate to the causes of incidence. Why is there a graded relationship between social position and health status that affects people at all levels of the social hierarchy? Are the factors determining health changing for the better? Is it the same for everyone? Where and for whom are they changing for the worse?

Why do they matter?

Today’s health landscape is very complex. Some of the features and trends include demands such as outcomes-based development, scaling up health systems with predominantly vertical disease intervention programs, and a general concern about the unsatisfactory performance of health systems.
Moreover, safe, proven and inexpensive interventions are not reaching those in need. Those with unmet needs are, disproportionately, those with lesser means. Too many people are worse off through encounters with the health system, and the number of people that suffer financial catastrophes and impoverishment due to health spending is sizeable.

Why a Commission on Social Determinants of Health (CSDH)?

The CSDH can do better because we will learn historical lessons and build on gains of previous eras. One strong and supporting example of the importance of the social determinants of health is the Millennium Development Goals (MDGs). They have become the new policy space, and they underscore the centrality of health and intersectoral connections that health, in the MDGs, requires; that is, action on social determinants.

How will the CSDH operate?

The CSDH will operate through a broad consultative process to produce strategic directions in two areas. One is evidence as knowledge for action, prioritizing learning in developing countries and focusing on a limited number of determinants. The second relates to leadership and advocacy through meetings, to engage real experiences of social disadvantage and civil society as a fundamental pillar to achieve sustainability. The emphasis will be on promoting action on social determinants of health in countries interested in or already using a social determinants approach to policy and programs with a view to demonstrate, document and evaluate policy, practice, leadership and scaling-up worldwide. The composition of the CSDH includes government leaders, knowledge networks, Commissioners, WHO staff, and partnerships between"experienced" countries that are collaborating with those beginning to implement.

What are the expected outcomes?

Progress can be achieved in a relatively short time. The CSDH's vision of a changed world assumes that social determinants of health will be incorporated into WHO’s planning, policy, strategy and technical work. That they will be incorporated into national policy development processes and that knowledge will be consolidated, and gaps clarified for action. Moreover, we will work with selected
countries towards improving health and reducing inequities.

Questions answered based on OPENING REMARKS ON BEHALF OF THE WORLD HEALTH ORGANIZATION (WHO): INTRODUCTION OF COMMISSIONERS FROM THE REGION OF THE AMERICAS AND THE COMMISSION ON SOCIAL DETERMINANTS OF HEALTH (CSDH)
Timothy Evans, Assistant Director General, Evidence and Information for Policy (EIP), WHO