Social determinants of health
Social determinants of health (SDOH) is defined as "the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. The Centers for Disease Control and Prevention CDC has written, "Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes.1 These conditions are known as social determinants of health (SDOH)." Social determinants of health have been recognized by several health organizations such as the Public Health Agency of Canada and the World Health Organization to greatly influence collective and personal well-being.  A list of determinants of health -- only some of which are social determinants -- compiled by the Public Health Agency of Canada is below:
- Income and social status
- Social support networks
- Education and literacy, e.g. health literacy
- Employment/Working conditions
- Social environments
- Physical environments
- Personal health practices and coping skills
- Healthy child development
- Biology and genetic endowment
- Health services
- Gender
- Culture
Disparities likely affect hospital rankings.

# History of SDOH
The term social determinants of health grew out of the search by researchers to identify the specific exposures by which members of different socio-economic groups come to experience varying degrees of health and illness. While it was well documented that individuals in various socio-economic groups experienced differing health outcomes, the specific factors and means by which these factors led to illness remained to be identified.  Overviews of the concept, recent findings, and an analysis of emerging issues are available. All these formulation share a concern with factors beyond those of biomedical and behavioural risk.
The SDOH National Conference list (see Raphael, below) is unique in that it specifically focuses on the public policy environment (e.g., income and its distribution) rather than characteristics associated with individuals (e.g. income and social status). These 11 social determinants of health are:
- Aboriginal status
- early life
- education
- employment and working conditions
- food security
- health care services
- housing
- income and its distribution
- social safety net
- social exclusion
- unemployment and employment security.
A particularly important issue that is emerging is whether any particular analysis of social determinants of health is de-politicized or not.  A de-politicized approach is one that fails to take account of the fact that the quality of the social determinants of health to which citizens in a jurisdiction are exposed to is shaped by public policy created by governments.  And governments of course are controlled by political parties who come to power with a set of ideological beliefs concerning the nature of society and the role of governments.
Such analyses that recognize the role played by politics outline the particular importance of having social democratic political parties in power.  Nations that have had longer periods of social democratic influence such as Norway, Finland, Sweden, and Denmark have government policymaking that is remarkably consistent with social determiannts of health concepts. Nations such as the USA and Canada, dominated by liberal and neo-liberal governing parties, much less so.  The work of David Coburn, Dennis Raphael, Toba Bryant, Clare Bambra, Richard Hofrichter, Carles Muntaner, and Vicente Navarro has been especially attentive to these issues.
An important development has been the Social Determinants of Health Listserv at York University.  Its 1200 members represent every state and provincial health authority in the USA, Canada, and Australia and also boasts membership by researchers, advocates, and concerned citizens from around the world.
You may subscribe to the SDOH list at .
In spite of these development and the remarkable accumulation of evidence concerning the importance of living conditions on health, public health practice and government and media attention in North America remains firmly focused on promoting "healthy lifestyles" and "healthy choices." Why this is the case has been the focus of attention by Dennis Raphael at York University who has written extensively on this topic.  Many of his writings and presentations can be found at: 

# Policy statements
- American Academy of Pediatrics
- American College of Physicians
- National Academy of Medicine
- Society of General Internal Medicine
- United States Preventive Services Task Force