# Social Determinants of Health

Social determinants of health (SDoH) are the non-medical conditions in which you are born, grow, live, work, and age. They include income, education, job quality, housing, neighborhood, social network, early-childhood development, and access to services. These conditions shape health outcomes and inequities. The WHO Commission on Social Determinants of Health (CSDH, 2008, chaired by Michael Marmot) framed inequities in power, money, and resources as the 'causes of the causes' of disease. The WHO estimates that SDoH account for 30 to 55% of health outcomes, more than clinical care does. In England, the Marmot Review 10 Years On (2020) documented stalled life expectancy and a widening gradient. Between 2016 and 2018, men in the most deprived tenth lived about 9.5 years less than those in the least deprived (women about 7.7 years less). And the gap in healthy life expectancy at birth was about 19 years, for both sexes (ONS). In Germany, the GISD-based analysis by Michalski et al. (2022) reports a life-expectancy gap of about 6.0 years for men and 3.2 years for women, between districts in the lowest and highest deprivation tenths (2015 to 2017 data).

## Sources

- Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet. https://doi.org/10.1016/S0140-6736(08)61690-6
- World Health Organization Commission on Social Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health — Final report of the Commission on Social Determinants of Health. WHO. https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1
- Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. (2020). Health Equity in England: The Marmot Review 10 Years On. Institute of Health Equity / The Health Foundation. https://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on
- Michalski N, Reis M, Tetzlaff F, et al.. (2022). Regional health differences – developing a socioeconomic deprivation index for Germany (GISD). Journal of Health Monitoring (RKI)

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