Explaining social determinants of health from a political economy of health and ecosocial perspective

Susanna Gunamany


Social determinants of health (SDH) is a common term used in public health and epidemiology. Public health researchers use social determinants of health to study various inequalities associated with health. Inequities in health involve systematic differences in health across population subgroups, thus changing the focus of influences from social interactions to societal characteristics. Several epidemiologic literatures focus on the social aspects of individuals and groups that are considered to influence the health status, which is conceptualized as 'average health'. Some studies look beyond the social factors affecting health; social determinants of health as arising from a social environment structured by government policies and status hierarchies, with social inequalities in health resulting from diverse groups being differentially exposed to factors that influence health, whereby 'social determinants', such as poverty, act as the 'causes of causes'. However, the most recent definitions of SDH include the factors such as political-economic systems, whereby health inequities result from the promotion of the political and economic interests of those with power and privilege and whose wealth and better health are achieved at the expense of those whom they subject to adverse living and working conditions. Hence, social determinants such as political-economic systems that prioritizes the highly concentrated accumulation of private wealth over the redistribution of power, property and privilege within and across countries constitute the 'causes of causes of causes'. In this paper, the concept of social determinants of health will be discussed in more detail, using two different theories of social epidemiology that focus on the SDH: the political economy of health and the ecosocial framework.


Social determinants of health, Ecosocial framework, Political economy of health, Public health, Health equity, Health inequity

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Marmot M. Social determinants of health inequalities. The Lancet. 2005;365(9464):1099-104.

Pickett KE, Wilkinson RG. The immorality of inaction on inequality. Br Med J. 2017;356.

Macinko JA, Starfield B. Annotated bibliography on equity in health, 1980-2001. Int J Equity Health. 2002;1(1):1.

Centres for Disease Control and Prevention. Social determinants of health: Know what affects health. Atlanta, GA: CDC. 2017. Available at: Accessed on 09 January 2022.

Starfield B. Are social determinants of health the same as societal determinants of health?-editorial. Health Promotion J Australia. 2006;17(3):170.

Krieger N, Alegría M, Almeida-Filho N, Da Silva JB, Barreto ML, Beckfield J, et al. Who, and what, causes health inequities? Reflections on emerging debates from an exploratory Latin American/North American workshop. J Epidemiol Community Health. 2010;64(9):747-9.

Krieger N. Epidemiology and the People's Health. Oxford: Oxford University Press. 2011.

Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30(4):668-77.

Bahri YY, Vosk R, Altman E, Vishwanath A. Localization and topology protected quantum coherence at the edge of hot matter. Nat Commun. 2015;6:7341.

Goud ML, Mohapatra SC, Mohapatra P, Gaur SD, Pant GC, Knanna MN. Epidemiological correlates between consumption of Indian chewing tobacco and oral cancer. Eur J Epidemiol. 1990;6(2):219-22.

Mishra GA, Pimple SA, Shastri SS. An overview of the tobacco problem in India. Indian J Med Paediatric Oncol. 2012;33(3):139.