Social determinants of

health state

Conf. Univ. Dr. Antonio SANDU

Historical evolution of the study of

health state social determinants
Debuts from the XIXth century, including studies and
referential observations regarding the relationship
between the standard of living/ standard of poverty and
health
Virchow (1848)
- the influence of poverty,
unemployment, lack of education, of political
environment on health
Durkheim (1897) suicide may be considered more like
a social issue, rather than an individual one
F. Engels (1844) poverty and unemployment
represent indicators of the low level of health

dorescu C. 2011, Determinanii sociali ai sntii.

zele sociale ale inegalitilor n sntate, Curs: Etica politicilor de sntate publi

a)

b)

In the middle of the 80s

Referential studies:
The Whitehall Studies on public officers: the
gradual relationship between the occupational
level and health existing in all occupational
levels, emphasizing the effect of social class
differences on health (morbidity and mortality
rates) Marmot and al., 1997
Pappas i al. (1993): differences between rates
of mortality among rich and poor, among the
ones with a higher educational level, and the
ones with a lower one.

After 1950
the influence of material depravation (poverty) on mortality

and morbidity rates has been revealed

G. Engel (1977) bio-psicho-social model through which

the pathogenical psichosocial factors (such as stress and

lifestyle) influence health/risk of getting sick.
Antonovsky (1987) the importance of individual
functioning (through means of understanding, management
and search of sense) through which the stressful factors may
be eliminated
empirical studies on the relationship between the income, the
level of education and the mortality rate (Kitagawa and
Hauser, 1973), the connection between these variables being
stronger for adults aged between 25 and 64.
the research debut regarding the relationship between the
level of health and the racial belonging.

dorescu C. 2011, Determinanii sociali ai sntii.

uzele sociale ale inegalitilor n sntate, Curs: Etica politicilor de sntate publ

Social determinants of health state

oltan V. , Savin S., urcan L., 2009 Analiza echitii n sntatea mamei i copilul
entrul pentru politici i analize n sntare, Chiinu

Two general currents regarding the

causes of inequalities in the health
system:

I.

The influence of the social-economic

status (SES)
The influence of the social environment

II.

dorescu C. 2011, Determinanii sociali ai sntii.

uzele sociale ale inegalitilor n sntate, Curs: Etica politicilor de sntate publ

Social status as determinant of health

state
The social status represents a complex factor that

contributes to the health states through its

components: age, gender, social-economical
status (educational level, occupation, income).
The components of social status constitute
important factors in determining the health state,
through the life and work conditions people can
chose between, or through the opportunity of
choosing a healthy lifestyle and high quality
medical services.
Pop C., STAREA DE SNTATE A POPULAIEI DIN ROMNIA N CONTEXT EUROPEAN. O ABORDARE DIN
PERSPECTIVA CALITII VIEII, CALITATEA VIEII, XXI, nr. 34, 2010, p. 274305

Income as determinant of health

state
The income represents an universal factor in
determining the inequalities in the health
system,
both at individual level,
and social level(CSDH, 2008, Anderson and
others, 2009).

Pop C., STAREA DE SNTATE A POPULAIEI DIN ROMNIA N CONTEXT EUROPEAN. O ABORDARE DIN
PERSPECTIVA CALITII VIEII, CALITATEA VIEII, XXI, nr. 34, 2010, p. 274305

Bogdan Voicu (2005) highlights the inter-relation

between welfare and health state,

emphasizing the role of health as an important
resource for the individual development, allowing
the participation in the working field and ensuring
the income needed to satisfy the needs.
We are dealing with a circular relationship
between occupation and health state.
A poor health state has an impact in the
chances of being hired, but in the same time,
unemployment contributes to a poor health
state, highlighting the following circuits: social,
emotional, behavioral and material. The biggest
effect is due to the lack of income. (European
Commission, 2003 apud Anderson, 2004: 57).
Pop C., STAREA DE SNTATE A POPULAIEI DIN ROMNIA N CONTEXT EUROPEAN. O ABORDARE DIN
PERSPECTIVA CALITII VIEII, CALITATEA VIEII, XXI, nr. 34, 2010, p. 274305

Education as a social determinant of

health state
The

educational level influences the life

strategies people developed in order to have a
better life,
Implicitly for maintaining a good health state
(Anderson, 2004, Precupeu, 2008),
through a higher level of informing and
information regarding health and the choice of
aPoplifestyle.
C., STAREA DE SNTATE A POPULAIEI DIN ROMNIA N CONTEXT EUROPEAN. O ABORDARE DIN
PERSPECTIVA CALITII VIEII, CALITATEA VIEII, XXI, nr. 34, 2010, p. 274305

The presence of a
well educated human resource and a better health state
determines a
higher work productivity, a better organizing of economical
activities,
a higher production, superior income. All these allow
investments in education and health, determining the
production of
a better educated and healthier human resource. On the
other side, healthier individuals will have
higher possibilities to get educated, whereas the better
educated individuals will be more
capable and willing to prevent diseases and take care of
their health. (Voicu, 2005: 94).

Age as a social determinant of

health state
Once you grow old, the health state will

depreciate.

Gender determinants of health

state
There are differences between the health status of

men and women.

Although women generally have a higher life
expectancy than men, they are more predisposed
to short term and chronic diseases.
Men
are more prone to fatal diseases
(cardiovascular diseases) (Zanden, 1988/1990)
Inequalities of gender regarding health status
come from both physiological differences, as well
as from the ones regarding the lifestyle (Zanden,
1988/1990).
Pop C., STAREA DE SNTATE A POPULAIEI DIN ROMNIA N CONTEXT EUROPEAN. O ABORDARE DIN
PERSPECTIVA CALITII VIEII, CALITATEA VIEII, XXI, nr. 34, 2010, p. 274305

Lifestyle as health status

determinant
The lifestyle a person adopts has a great impact
on his/her health state:
through risk behavior (alcohol consumption,
nicotine, drugs, etc.),
eating habbits, physical activities,
ways of spending free time,
limitating stress,
preventing diseases.

Also, the health related values and attitudes are

also very important, influencing health related

behaviors. (Precupeu, 2008).
Attitudes, values and health related behaviors
have a social-cultural component, a huge part of
those being culturally determined (Zanden,
1988/1990)

Pop C., STAREA DE SNTATE A POPULAIEI DIN ROMNIA N CONTEXT EUROPEAN. O ABORDARE DIN
PERSPECTIVA CALITII VIEII, CALITATEA VIEII, XXI, nr. 34, 2010, p. 274305

Pop C., STAREA DE SNTATE A POPULAIEI DIN ROMNIA N CONTEXT EUROPEAN. O ABORDARE DIN
PERSPECTIVA CALITII VIEII, CALITATEA VIEII, XXI, nr. 34, 2010, p. 274305

Social vulnerability
From the social determinants perspective, an

individual is not inherently vulnerable, but

transforms additional factors such as: poverty,
inadequate living conditions, receiving inferior
quality
services,
disadvantageous
legal
regulations, power manifestations and family
inequalities including institutions, structures,
hierarchies, politics.
Vulnerability may lead to addiction situations, and
coming from the others: stigmatization and social
exclusion.
oitu D., Rebeleanu A., Oprea l., 2013, POLITICILE PUBLICE SOCIOMEDICALE,
NTRE VULNERABILITI I RISCURI , Revista Romn de Bioetic, Vol. 11, Nr. 1, Ianuarie - Martie 2013

From a social point of view, risk situations and

vulnerability state may be foreseen, prevented or,

when that is not possible, limitated, overcome,
and the person can be supported into social
reintegration by activating its own forces, by
identifying the best way to face issues, by
promoting time reducing solutions.
The intervention actions subscribe, on one side,
In the social insurance system,
and on the other side, the social assistance one.

oitu D., Rebeleanu A., Oprea l., 2013, POLITICILE PUBLICE SOCIOMEDICALE,
NTRE VULNERABILITI I RISCURI , Revista Romn de Bioetic, Vol. 11, Nr. 1, Ianuarie - Martie 2013

The general objectives of medical assistance

services and activities take into account:
communitys implication in identifying medicalsocial problems;
defining and characterizing medical-social issues
of the community;
development of intervention programs regarding
medical assistance;
adapted to the needs of the community;
monitoring and evaluating medical assistance
services and activities
ensure the efficiency of actions and use of
resources.
oitu D., Rebeleanu A., Oprea l., 2013, POLITICILE PUBLICE SOCIOMEDICALE,
NTRE VULNERABILITI I RISCURI , Revista Romn de Bioetic, Vol. 11, Nr. 1, Ianuarie - Martie 2013