Learning Objectives
What you'll learn this week
Week Overview
Core concepts and explanations
Why do some people get sick more often than others? Why do people in certain neighbourhoods live longer than others? The answers lie in the determinants of health, which are all the factors that influence whether a person stays healthy or becomes unwell. There are different ways to think about health. The biomedical approach focuses on the physical body, treating disease as caused by biological problems like infections or injuries. The social approach looks at the bigger picture: how living conditions, relationships, work, culture, and community shape our health. Both perspectives are important and complement each other.
Social determinants of health are the broad social, economic, and environmental conditions in which people are born, grow up, work, and age. These include income, education, employment, housing, social support, and the neighbourhoods where people live. Research shows that social determinants account for between 30-55% of health outcomes, which is often more than healthcare services themselves contribute. This is why social determinants are sometimes called the 'causes of the causes': they are the underlying conditions that influence all other health factors. The social gradient in health means that health outcomes improve at each step up the socioeconomic ladder, not just for the very poorest but at every level. For example, infant mortality is closely linked to maternal education, and under-5 mortality rates improve with each increase in household wealth.
Individual determinants of health are the personal characteristics unique to each person that influence their health: biology and genetics (family history of disease), health behaviours (diet, exercise, smoking, alcohol use), mental health and emotional wellbeing, chronic health conditions (diabetes, asthma), gender and sex (which influence disease patterns and symptom presentation), age and stage of life, and health literacy (the ability to understand health information and navigate the healthcare system). For paramedics, understanding these determinants is vital. A patient's presentation in an emergency is shaped by all these factors working together. A man with a family history of heart disease, who works night shifts in a stressful job, lives in insecure housing, and has limited health literacy is at much greater risk than someone without these accumulated disadvantages. Recognising these factors helps paramedics provide more effective, patient-centred care.
The determinants of health encompass the full range of factors that influence health status at both the individual and population levels. Conceptual frameworks for understanding health range from the biomedical model, which centres on biological pathology and clinical intervention, to social models that emphasise the role of socioeconomic, cultural, and environmental conditions. The Dahlgren and Whitehead (1991) framework is a widely referenced model that depicts determinants as concentric layers, with individual factors (age, sex, genetics) at the centre, surrounded by lifestyle factors, social and community networks, living and working conditions, and general socioeconomic, cultural, and environmental conditions at the outermost ring. Critically, population-level research demonstrates that the outer layers exert a greater aggregate influence on population health outcomes than the inner layers.
Social determinants of health (SDOH) are defined as the conditions in which people are born, grow, live, work, and age, and the wider set of forces and systems shaping the conditions of daily life. The WHO Commission on Social Determinants of Health (2008) established that social determinants account for 30-55% of health outcomes, and that the contribution of sectors outside health to population health outcomes exceeds that of the health sector itself. SDOH are characterised as 'causes of the causes' because they shape exposure to behavioural, environmental, and biological risk factors. Key social determinants include socioeconomic position (income, education, occupation), which operates through the social gradient in health, a graded relationship whereby health outcomes improve incrementally at each level of the socioeconomic hierarchy (Marmot, 2004). This gradient is observed across all societies, both between and within nations, manifesting in infant mortality differentials by maternal education, under-5 mortality by household wealth quintile, and all-cause mortality by neighbourhood deprivation. Additional social determinants include early childhood development (which establishes the foundation for lifelong health, learning, and economic participation), social exclusion (marginalisation through poverty, discrimination, and cultural barriers), social capital (the health benefits derived from social networks and cohesion), employment and working conditions (with unemployment associated with increased mortality, morbidity, and psychological distress), and housing quality and the built environment (where precarious housing is associated with poorer health outcomes in a graded fashion).
Individual determinants of health comprise the personal biological, behavioural, and psychological characteristics that modify a person's susceptibility to disease and their response to treatment. These include genetic predisposition (family history of conditions such as cardiovascular disease, diabetes, or autoimmune disorders), health behaviours (diet, physical activity, smoking, alcohol consumption, medication adherence), mental health status (depression, anxiety, and coping capacity, which influence both physical health and healthcare-seeking behaviour), chronic health conditions (which alter baseline health and increase vulnerability to acute events), sex and gender (which influence disease epidemiology, symptom presentation, and healthcare interactions), age and life stage (with distinct risk profiles across the lifespan), and health literacy (the capacity to obtain, process, and act on health information). For paramedic practice, recognising the interplay between individual and social determinants is essential for understanding why presentations differ between patients in ostensibly similar circumstances, and for delivering equitable, contextually appropriate care. Australian data demonstrate that behavioural risk factors such as physical inactivity, obesity, harmful alcohol use, and smoking are not uniformly distributed but vary systematically by age, socioeconomic status, geography, and Indigenous status, reflecting the influence of social determinants on individual behaviour.
Key Terms
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Determinants of Health
The range of personal, social, economic, and environmental factors that influence the health status of individuals and populations.
Social Determinants of Health
The broad social, economic, and environmental factors that impact health outcomes, including income, education, work, and housing.
Social Gradient in Health
The pattern where health outcomes improve at each step up the socioeconomic ladder.
Socioeconomic Standing
An individual's position in society determined by their income, education, and occupation.
Social Exclusion
A broad term describing social disadvantage and a lack of resources, opportunities, involvement, and skills.
Social Capital
The benefits derived from the ties that unite and bind people within and across groups.
Health Literacy
The ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health.
Health Behaviours
Actions individuals take that affect their health, including diet, physical activity, smoking, alcohol use, and medication adherence.
Biomedical Approach
A perspective that views disease as caused by biological problems such as infection, injury, or cellular malfunction, focusing on physical diagnosis and treatment.
Biology and Genetics
Inherited genetic traits and biological characteristics that can increase or decrease an individual's risk of developing certain diseases.
Lecture Materials
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Matching Game
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End of Week Test
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Paramedicine Case Study
Apply this week's concepts to a realistic paramedicine scenario.