Social Determinants of Health

Social determinants of health are the social, economic and environmental conditions in which people are born, grow, live, work and age. They shape exposure to risks, access to resources and care, and both physical and psychological outcomes beyond biology or individual behaviour alone.

Determinants and pathways

Resources, opportunities and power operate through structural determinants, such as social stratification and public policy, and intermediary conditions such as deprivation, stress, occupational risks and healthcare access.

• Income, employment and education affect nutrition, housing, working conditions, health knowledge and the ability to obtain care.
• Caste, class and gender can shape discrimination, autonomy, occupational exposure and access to food, sanitation and healthcare.
• Housing, sanitation, clean air, early-childhood conditions, social support and public services influence well-being across the life course; systematic, avoidable and unfair differences constitute health inequities.

Mental health, well-being and substance-use vulnerability

Social determinants shape mental health through material security, safety, autonomy, belonging and exposure to psychosocial stress. Supportive families, institutions and communities can strengthen resilience, while accumulated adversity can impair psychological well-being.

• Poverty, insecure employment and limited educational or recreational opportunities can generate stress, hopelessness and social exclusion, increasing susceptibility to harmful coping.
• Family conflict, violence, neglect, bereavement and other adverse experiences can weaken emotional security.
• School disengagement, peer influence, community norms and easy availability can increase youth exposure to substances.
• Stigma, criminalisation, poor mental-health support and inaccessible services can delay early identification and treatment, allowing dependence and associated harms to deepen.

Displacement and public-health response

Prolonged displacement compounds disadvantage by disrupting shelter, livelihoods, community networks and institutions simultaneously.

• Overcrowding, unsafe water, poor sanitation and inadequate nutrition increase disease and injury; lost income or documents can restrict schooling, food support and social protection.
• Interrupted maternal care, immunisation, chronic-disease treatment and medicine supplies weaken continuity of care; trauma, bereavement, uncertainty and isolation increase mental-health needs.
• Women, children, older persons, persons with disabilities and marginalised groups may face greater barriers, violence and protection risks.
• The National Health Policy, 2017 supports preventive, promotive and cross-sectoral action. A Health in All Policies approach should combine continuous primary care with housing, education, livelihoods, sanitation, social protection, community participation and focused support.