A Shift in Approach to Addressing Public Health Inequities in Considering Societal Structural and Systemic Drivers and Their Impact on Social Determinants of Health

Abstract

In this report, we discuss the distinction between social determinants of health (SDOH) and the structural and systemic drivers of health (SSD). We propose that, while SDOH are the conditions in which people are born, grow, live, work, and age that influence health outcomes; SSD are the social, cultural, political, and economic contexts that create and shape the SDOH. Integrating constructs from widely cited examples, we propose an SSD model that broadens the contextual impact of these driving forces or factors rooted within the Centers for Disease Control and Prevention’s SDOH framework. The SSD model 1) presents systems and structures as multidimensional; 2) considers 10 dimensions as discrete and intersectional; and 3) acknowledges health-related impacts over time at different life stages and across generations. We also present an application of this SSD model to the housing domain and describe how SSD impact SDOH through multiple mechanisms that may lead to unequal resources, opportunities, and consequences contributing to disproportionate burden of disease, illness, and death within the US population. This approach to enhancing the SDOH framework offers an innovative and promising model for multi-dimensional, collaborative public health approaches toward achieving health equity and eliminating health disparities.

Note:

Funding Information: None.

Conflict of Interests: None.

Keywords: Health Equity, Social Determinants of Health, Structural and Systemic Drivers of Health, Public Health

JEL Classification: I