- + Key points: Social determinants
Latest available information
• 52.9% of adults aged 16 years and over (53.7% of men and 52.2% of women) felt they were able to ask neighbours to care for a child as estimated from the 2013 NSW Adult Population Health Survey (self reported using CATI, computer-assisted telephone interviewing).
• 77.9% of adults aged 16 years and over (75.9% of men and 79.8% of women) reported running into friends when shopping in local area as estimated from the 2013 NSW Adult Population Health Survey (self reported using CATI, computer-assisted telephone interviewing).
• 77.0% of adults aged 16 years and over (77.2% of men and 76.9% of women) said that most people can be trusted as estimated from the 2013 NSW Adult Population Health Survey (self reported using CATI, computer-assisted telephone interviewing).
• 75.2% of adults aged 16 years and over (83.5% of men and 67.0% of women) reported feeling safe walking down the street after dark as estimated from the 2013 NSW Adult Population Health Survey (self reported using CATI, computer-assisted telephone interviewing).
• 68.2% of adults aged 16 years and over (64.8% of men and 71.4% of women) reported that they would be feeling sad to leave neighbourhood as estimated from the 2013 NSW Adult Population Health Survey (self reported using CATI, computer-assisted telephone interviewing).
• 59.5% of adults aged 16 years and over (61.7% of men and 57.4% of women) visited neighbours at least once in a week as estimated from the 2013 NSW Adult Population Health Survey (self reported using CATI, computer-assisted telephone interviewing).
• Measures of social capital related to safety and social reciprocity were higher in rural compared to urban areas. By contrast, rates of assault and robbery reported to police were higher in rural areas in recent years.
- + Background: Social determinants
Social determinants of health are the economic and social conditions under which people live, which determine their health. The conditions most frequently regarded as social determinants of health are: individual and household income and income distribution in the society; employment and working conditions; education and literacy, including health literacy; housing; health and social services, including early childhood development support; and social cohesion. These factors are resources that a society makes available to its members to enable them to stay healthy, and, in broader terms, to equip them with ‘the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment’ (Rafael 2008). Together with SEIFA measures these factors are considered in depth in the indicators included in HealthStats NSW.
Social capital is defined in a variety of ways in social sciences, however all definitions, interpretations and uses share the central concept ‘that social networks have value’ (Putnam 2000). In the simplest terms social capital can be described as a collective mental disposition, close to the spirit of community or as the collective benefits derived from the cooperation between individuals and groups. Unlike the traditional forms of capital, social capital is not depleted by use, and the opposite is true: it is depleted by non-use.
Many studies measure social capital by asking the question: ‘do you trust the others?’. Another common way of measuring social capital is analysis of the participation in voluntary associations or civic activities.
The presence of social capital through social networks and communities has a protective quality on health. Social capital affects health risk behaviour in the sense that individuals who are embedded in a network or community rich in support, social trust, information, and norms, have resources that help achieve health goals. Inversely, a lack of social capital can impair health (Lin 2006).
Burden of disease
Australia ranks among the most advanced nations in the world according to the UN Human Development Index, which measures some aspects of national socioeconomic conditions (see Methods tab) (WHO 2008). However, the health burden in the Australian population attributable to relative socioeconomic disadvantage is large and much of this burden is potentially avoidable (Turrell et al. 2006). Socioeconomically disadvantaged groups experience more ill health, and are more likely to engage in behaviours or have a risk factor profile consistent with their poorer health status (Turrell et al. 2006). These inequalities are important from both social justice and economic perspectives – they are ‘unfair’, preventable and have high direct and indirect impact on the health system (Sainsbury et al. 2001).
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO, 2008. Available at http://www.who.int/social_determinants/final_report/en/
Lin N. Building a network theory of social capital. In: Lin N, Cook K, Burt RS (eds). Social capital: Theory and research (pp.3-29). New York: Aldine de Gruyter, 2006.
Putnam R. Bowling Alone: The Collapse and Revival of American Community. Simon and Schuster, 2000.
Rafael D (eds). Social Determinants of Health: Canadian Perspectives. 2nd ed. Toronto: Canadian Scholars' Press, 2008.
Sainsbury P, Harris E. "Health inequalities: Something old, something new". New South Wales Public Health Bulletin 2001; 12: 117-9.
Turrell G, Stanley L, de Looper M, Oldenburg B. Health Inequalities in Australia: Morbidity, health behaviours, risk factors and health service use. Health Inequalities Monitoring Series No. 2. AIHW Cat. No. PHE 72. Canberra: Queensland University of Technology and Australian Institute of Health and Welfare, 2006. Available at http://www.aihw.gov.au/publications/index.cfm/title/10272
- + Interventions: Social determinants
The World Health Organization established the Commission on Social Determinants of Health in 2005. It outlines what can be done to promote health equity and aims to foster a global movement to achieve it. In its 2008 report the Commission provides the evidence and actions recommended to be put in place by all governments to work towards “Closing the gap in a generation: health equity through action on the social determinants of health” (WHO 2008).
The three principles of action on the social determinants of health from the WHO report are: 1. Improve the conditions of daily life - the circumstances in which people are born, grow, live, work, and age; 2. Tackle the inequitable distribution of power, money, and resources - the structural drivers of those conditions of daily life - globally, nationally, and locally; and 3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health (WHO 2008). There have been many publications reporting on progress of the initiatives since.
In Australia, the four leading public health organisations issued a statement at their joint congress in 2008 calling "...on government at all levels, industry, civil society and other key stakeholders at [sic] act effectively on the social determinants of health that underpin many of the causes of ill health in our society and that lead to unfair health outcomes" (PHC 2008).
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO, 2008. Available at: http://www.who.int/social_determinants/final_report/en/
Population Health Congress. Congress Declaration. PHC. 2008. Available at: https://aea.asn.au/documents/conferences/251-health-congress-call-for-action/file
- + For more information: Social determinants
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
Healthdirect at http://www.healthdirect.gov.au
World Health Organization. Social determinants of health. Available at: http://www.who.int/social_determinants/en/