The Determinants of Health

Factors that Determine Good or Poor Health

Health Poverty Action believes that everyone has the right to health. But making that right a reality is about more than ensuring everyone can visit a clinic or doctor.

A multitude of different social, economic and cultural factors determine a person’s health. This means that people living in the same community, or people of the same age, can have vastly different chances of good health.

Instinctively you might think that access to health services is the biggest factor in determining health. But many other things significantly affect our likelihood of good health. It can also be easy to blame individuals for their poor health, or congratulate others for good health, yet in reality many of the determinants of health are out of our own personal control.

Underlying these broad factors is a much deeper level of structural causes, which are more difficult to change. These can be summarised as the distribution of money, power and resources at global, national and local levels.

Some of the main ‘determinants of health’ include:

  • Where you live: is there clean and safe water and air? Is housing safe and not overcrowded? Is there good sanitation? What are levels of crime like? How safe are roads? Are there jobs with decent working conditions?
  • Genetics: have you inherited greater likelihood of certain illnesses? How do you cope with stress?
  • Income: unsurprisingly, higher income is linked with better health.
  • Nutrition: can you regularly eat enough healthy food?
  • Education: going to school can improve many other determinants of health.
  • Relationships with friends and family: better support networks are linked with better health.
  • Gender: men and women face different diseases at different ages. In many countries women also face many extra challenges that affect their health.
  • Culture: customs, traditions and beliefs can all affect health for better or worse.
  • Social status and social exclusion: people who are excluded, or on the margins of society have worse health chances.
  • Access to and use of health services: are services available nearby to prevent and treat poor health?
  • Personal behaviours: What do you eat? How much exercise do you do? Do you smoke or drink?
  • All these health determinants interact to create a complex set of health dynamics. But reducing poverty, providing livelihoods, increasing access to education and promoting gender equality are key parts of the puzzle.

Increasing amounts of attention are being paid to how these factors and others impact on people’s health.  One example is the Commission on Social Determinants of Health which presented its report ‘Closing the Gap in a Generation. Health equity through action on the social determinants of health’ in 2008. It has focused on the social aspects known to be among the worst causes of poor health and inequalities between and within countries. The causes identified include unemployment, unsafe workplaces, urban slums, globalisation and lack of access to healthcare.

Unfortunately, however, measures to address the underlying structural causes of poor health are often buried, as they challenge the global status quo of power and resources. Actions that campaigners would like to see in this area include the use of progressive taxation and the elimination of tax evasion; much stronger regulation of commercial activities, such as those created by the tobacco, alcohol, breast-milk substitutes, high fat and sugar processed food; and the provision of equitable universal health care coverage including high quality promotive, preventive, curative and rehabilitative health services throughout the life cycle.


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