The Social Determinants of Health: Coming of Age

Paula Braveman, Susan Egerter, and David R. Williams

Center on Social Disparities in Health, Department of Family and Community Medicine,
University of California, San Francisco, California 94118; email: braveman@fcm.ucsf.edu,
egerters@fcm.ucsf.edu
School of Public Health, Harvard University, Boston, Massachusetts 02115;
email: dwilliam@hsph.harvard.edu
Annu. Rev. Public Health 2011. 32:3.1–3.18
The Annual Review of Public Health is online at
publhealth.annualreviews.org
Abstract
In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant
knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health.
We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research priorities, focusingon upstream social determinants—including economic resources, education, and racial discrimination—that fundamentally shape the downstream determinants, such as behaviors, targeted by most interventions.
Research priorities include measuring social factors better, monitoring social factors and health relative to policies, examining health effects of social factors across lifetimes and generations, incrementally elucidating pathways through knowledge linkage, testing multidimensional interventions, and addressing political will as a key barrier to translating knowledge into action