The Social Determinants Of Health

Most recently, social epidemiologists and other researchers have focused on identifying the social equivalents of leaded gasoline and environmental tobacco smoke. Among the greatest advances in understanding the factors that shape population health over the last two decades, and clearly since the last Institute of Medicine (IOM, 1988) report on the health of the public, has been the identification of social and behavioral conditions that influence morbidity, mortality, and functioning.

The evidence amassed strongly and consistently points to the importance of these conditions as significant determinants of population health. Because they also feature prominently in the committee's determinants-of-health model, the evidence related to four conditions whose importance is robustly supported is reviewed here: (1) socioeconomic position, (2) race and ethnicity, (3) social networks and social support, and (4) work conditions. Additionally, we discuss the evidence related to a fifth condition that has been and that still is the subject of great interest as well as controversy: ecological-level influences, namely, economic inequality and social capi-tal.3 The present analysis reviews key evidence related to these five conditions that has been presented more extensively in Health and Behavior (IOM, 2001).

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