What causes heart disease? To some, the clear answer would be blocked arteries. But what causes those arteries to become blocked? Perhaps it’s the unhealthy food and drink people consume, their lack of exercise, or their stress levels. And what, in turn, makes them feel stressed, shapes their opportunities to be active and determines their choices about what they eat and drink?

The answers lie in the circumstances in which people are born, grow, live, work and age: the social determinants of health (see Box 1). These can enable individuals and societies to flourish, or not. These are the causes of the causes.

The Health Foundation has written this guide as a brief introduction to the social determinants of health. It explains how a person’s opportunity for health is influenced by factors outside the health and social care system. It also shows that many people don’t have the same opportunities to be as healthy as others.

With the help of short case studies, it highlights how action can create improvements in the health of the whole population, for the lasting benefit of individuals, society and the economy.

The guide has been written for anyone with an interest in people’s health and wellbeing. It will be especially useful to those new to the social determinants of health.

Why focus on the social determinants of health?

A person’s opportunity for good health starts long before they need health care., So, there is a compelling case that responsibility for the health of the public should go beyond the health and social care system to span all of society.

A wide range of organisations – across government, the voluntary sector, the private sector, media, advertising and local communities – have it within their power to improve people’s health. By acknowledging and acting on this, it is possible to harness a multitude of opportunities to overcome the big health challenges of today.

Box 1: The factors that influence health and wellbeing – terminology and scope

Throughout this guide we use the term ‘social determinants of health’. These are sometimes also called the wider determinants of health. When we use the term, we are referring to the social, cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age.

The health and social care system is also an important social determinant of health that supports everyone at different points in their lives. However, this guide focuses beyond health and social care to areas where there is untapped potential for local and national action to support healthier lives.

* The term ‘causes of the causes’ refers to the underlying causes of health problems. Find out more: Rose G. Sick individuals and sick populations. International Journal of Epidemiology. 1985;14(1):32–8.

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