Social determinants of health

• The social determinants of health (SDOH) are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics (WHO, 2014).
• Determinants are factors at a system, social or community level that affect the likelihood that people will be exposed to or develop a disease or condition.
• Australian research has identified three key social determinants of mental health and wellbeing: social inclusion, freedom from violence and discrimination, and economic participation or income security.
• A range of interrelated concepts and frameworks inform, and are informed by an SDOH approach, including:
  • Health promotion
  • Human rights
  • Inequality
  • Community wellbeing
  • Social responsibility within health professions

Professor Tim Carey, clinical psychologist, Centre for Remote Health, Flinders University

Tim Carey talks about how working in Alice Springs transformed his understanding of the social determinants of health. He explains Michael Marmot’s key theory about the social gradient, and argues that the social determinants of health should feature in the undergraduate psychology curriculum as it provides essential social context to people’s lives.

Carmel O’Brien, counselling psychologist, Director, Clinical Services, Doncare

Carmel O'Brien highlights the importance of recognising the context in which people live; she talks about how practitioners can better assist clients to understand how violence, poverty or other life experiences affect their mental health - and what they can or cannot change.

Associate Professor Dawn Darlaston-Jones, community psychologist, University of Notre Dame

Dawn Darlaston-Jones stresses the importance of understanding the macro issues when tackling the micro issues which are often the focus of psychology. She gives an example of the social determinants of health in practice - it is the discrimination that gay people experience that is problematic, not being gay itself.

​There are many reasons why psychologists should address the social determinants of health in their work:

• Our health and wellbeing are influenced by far more than the health care system, or the individual choices we make.
• Psychologists can do much more than provide treatment, they can promote equity of access to services, and help to reduce health inequities through action on social determinants.
• The number of people in need of treatment far outweighs the supply of practitioners. Systems-level intervention is also required.
• The increasing numbers of people with mental illness are inequitably distributed across the population, indicating that mental illness is more prevalent amongst disadvantaged groups.
• Psychologists have a responsibility to uphold justice and challnge discrimination, as set out in the APS Code of Ethics.

Our work promoting the social determinants of health is one way the APS has responded to its mission to advance the discipline and profession of psychology for the benefit of members and the communities they serve.

The APS endorsed the World Health Organisation’s (WHO) social determinants of health approach in 2012, acknowledging the social gradient in health and recognising the contribution of social determinants to unequal health outcomes.

The APS joined the Social Determinants of Health Alliance in 2013. The Alliance was established by organisations from health, social services and public policy to work with governments to reduce health inequities in Australia.

The APS has developed a resource to assist psychologists seeking to adopt an SDoH approach to their work with clients, and to expand their thinking about mental health to include how to help people keep it, not just how to get it back

The Professional Development in 2017 delivered a webinar series based on this work, which explored the value of examining the physical, economic, political, personal and social environments that affect people's everyday lives and wellbeing.

1. Douglas, B., Friel, S., Denniss, R. & Morawetz, D. (2014). Advance Australia Fair? What to do about growing inequality in Australia: Report following a roundtable held at Parliament House Canberra in January 2014. Weston, ACT: Australia21.
2. May, J., Carey, T.A., & Curry, R. (2013). Social determinants of health: Whose responsibility? Australian Journal of Rural Health, 21, 139-140.
3. UCL Institute for Health Equity (2013). Working for health equity: The role of health professionals.
4. Vichealth (2013). Fair foundations: The Vichealth framework for health equity.
5. WHO (2014). What are social determinants of health?
6. WHO (2005). Promoting Mental Health Concepts, Emerging Evidence, Practice: a summary report of the World Health Organisation, Geneva, World Health Organisation in collaboration with the Victorian Health Promotion Foundation (VicHealth) and the University of Melbourne. [H. Herrman, S. Saxena & R. Moodie (eds)]
7. WHO (1986). Ottawa Charter for Health Promotion. Geneva: WHO.