Social Gradient and Social Determinants of Health

Social gradient in health refers to the difference in socioeconomic spectrum amongst populations. The World Health Organization (2009) states that: “social gradient means that health inequities affect everyone”. WHO further explains that in a country, it can be found that generally the lower an individual’s socioeconomic position the worse their health, and that social gradient in health runs across the socioeconomic spectrum from the top to bottom. Social gradient mirrors one or population cluster’s place in society and the disparities in access to social determinants of health such as employment, education, and others. The social gradient can be measured using modalities such as mortality and morbidity rates in either adults or children under five years, disease prevalence and incidence within a population, differences in household wealth quintile. The concept of the social gradient is based on three concepts namely health inequities/inequalities, and social determinants of health. Health inequities are defined as inequalities in health between groups of people within and between countries. Socio-economic factors and their impacts on the lives of people are a major determinant of the risk of illness and the subsequent measures taken to counteract the illness. Social determinants on the other hand encompass the situations in which one is born and brought up till his/her death and the structures put in place to counteract illness. These determinants are from the onset modeled and based on economic, social, and political policies.

Social determinants of health are very important if disease and illness are to be controlled fully within populations and ensure equality for health opportunities for all people. A study carried out by Kosteniuk and Dickinson (2003) found out that social determinants of health such as socioeconomic and demographic indicators, social support, social involvement, and self-esteem, high income, and employment greatly influenced one’s health. For example, employment was positively related to better physical and self-reported health status. From the findings of this study, it is evident that social determinants of health are important in ensuring equality in health opportunities. Starfields (2006) appreciates the fact that “social characteristics of either an individual or groups influence health; average health” (p. 170). People constantly interact with one another (social beings) and any aspect of their life that may or may not affect their health must be considered as this will ensure that all people that an individual interacts with are also considered. Social determinants according to Richard & Marmot (2003, pp. 12-28) are stress, early life, social exclusion, work, unemployment, social support, addiction, food, and transport. The life expectancy gap between countries has increased greatly in the last two decades. This is attributed to new diseases, improvement in quality of life, and new measures put in place to counteract and address threats to human health and well-being. In developed countries, the has been an upward trend in life expectancy while in the developing countries, there has been a downward trend in life expectancy owing to the increased food insecurity, political instability, effects of climate change, and high increase in disease burden. This has led to more human suffering and inequality in health while in developed countries it is the opposite.

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According to Raphael (2006), three options can be used by health promoters to address inequalities in health. These include, “educate, motivate and activate” (p. 168). Educating the public about social determinants of health; increasing income and health inequality, persistent poverty, poverty, housing, food insecurity, and social exclusion will empower the public with knowledge on what needs to be done and will make them participate in their health. Study findings and results can be availed to the public to make them take personal initiatives to address inequalities in health. Health promoters can also motivate the public, professionals, and policymakers to shift towards social determinants of health hence inequality in health (Raphael, 2006, p. 168). This will allow the views and voices of those affected most by social determinants of health to be heard, this will further transform their views and voices into political activity on their part and policy action concerning inequality health on the part of the government agencies and other stakeholders in the health sector. The third and final option is activated which involves supporting political goodwill and action that favors health. Raphael (p. 168) recognizes the fact that the quality of any social determinants of health within a jurisdiction is shaped by the political ideology of governing parties. Government policies on health systems determine the levels of inequality in health and health promotion practitioners must therefore work towards ensuring that policies governing health care services and systems are fair and offer equal opportunity for all to access health care services.


  1. Kosteniuk, J. G., & Dickinson, H. D 2003, ‘Tracing the social gradient in the health of Canadians: primary and secondary determinants’, Soc Sci Med, vol. 57, no. 2, pp.263-76.
  2. Raphael, D 2006, ‘The social determinants of health: what are the three key roles for health promotion?,’ Health Promotion Journal of Australia vol. 17, no. 3, pp. 167-170
  3. Richard, W., & Marmot, M. Ed 2003, Social determinants of health: the solid facts. 2nd edition, WHO Publication.
  4. Starfields B 2006, ‘Are social determinants of health the same as societal determinants of health?’, Health Promotion Journal of Australia , vol. 17 no.3, pp. 170-174
  5. WHO, 2009, Social determinants of health: key concepts Web.

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