The social determinants of health and health disparities

"If you ask most people what influences health, almost invariably the first reply will be health care-the services that individuals receive from physicians, nurses, and other medical professionals to treat or prevent illness, also called medical care. Many people, in fact, presume the role of health care (medical care) in affecting health to be so predominant that they often use the terms health and health care interchangeably. Many people would probably also cite behaviors such as diet, exercise, smoking, and use of alcohol or drugs as key influences on health. While ample evidence supports the importance of both health care and behaviors for health, a compelling body of scientific knowledge now calls for a wider and deeper set of explanations for why some of us experience good health and others do not. This body of knowledge challenges us to think beyond common assumptions about the key causes of health and illness, to ask not only "What influences health?" but also "What factors shape those influences?" i.e., "What influences the influences?" This knowledge tells us that, to achieve real and lasting improvements in health, we must shift the focus to identifying and addressing the root or fundamental causes(Link and Phelan 1995)-the underlying factors that set in motion other factors that may be more easily observed but play a less fundamental role in shaping health. Ethical concerns, furthermore, require us to focus not only on a population's overall or average health, but also on health equity-whether everyone has a fair and just opportunity to be as healthy as possible, which includes whether the resources, opportunities, and conditions required for good health are distributed equitably within the population."