Determinants of health: Overview

The determinants of health are the biological, psychological, behavioural, social, economic, and environmental factors that determine the health of individuals and populations. Socially or politically conditioned inequalities in the distribution of determinants lead to inequities in health within or between countries. The ways that determinants act on health are complex, involving interactions between factors and effects occurring over differing timespans. These complexities present challenges for research and public policy, to understand and take action on determinants, to improve population health, and/or to reduce health inequities. In this chapter we review the four main categories of biological, behavioural, social, and environmental determinants. We then discuss the topic of social determinants of health in more detail and review a number of the main factors identified in contemporary public health literature; from education, employment, and gender to determinants of Indigenous health, and commercial determinants of health. In a later section of the chapter (‘The complexity of determinants and their interactions’) we look at some of the challenges raised by the complex, multifactorial nature of determinants of health for research, health practice, and policy action. In the final section, we discuss two particular political challenges facing governments and international bodies seeking to take action on determinants of health and health equity.