Social determinants of health

The social determinants of health are the socioeconomic circumstances that affect our life expectancy and the quality of our health.

These include: social connections; individual and collective control; our surroundings; jobs and income; local economies; housing and education and skills. 

The evidence we have collected from our own evaluations and research from our peers suggests that, in particular, social connections and collective control are critical foundations if we are to address some of the wider issues driving ill health.

We also recognise that many people with shared identities, experiences, characteristics or common interests face additional barriers to good health due to discrimination and further inequality. This is why we fund Communities of Interest as well as neighbourhood based projects.

Find out more below about how these circumstances affect our health and how projects funded by the Trust are addressing them.

Social connections

Strong social connections within and between communities is one factor in achieving good health and living longer lives. Social connections protect health and are also a very important foundation for other positive changes to health and wellbeing.

All of our funding programmes place a strong emphasis on building social connections as the foundation for increased confidence, skills, voice and aspiration. Evidence from multiple sources, including our funding programmes, demonstrates how effective the Trust’s programmes are in supporting people to develop meaningful social connections.

"Anxiety can be crippling.  It can rule your life. Fundamentally, we’re social beings and coming together and connecting with other people is healing in itself.” Diane, member and volunteer, Anxiety CafĂ©, Independent Arts (Active Communities 2019-2021)

Examples of how funded partners are fostering strong social connections

Find out more about our evidence on social connections

Individual and collective control 

When people have control over their lives and the decisions that affect them, they are able to improve and maintain their health. Collective control is power exercised by groups of people, and this group power also affects health.

There is a strong body of evidence which demonstrates that people and communities need to have greater power over the decisions and actions that affect their lives in order to improve and maintain their health. Collective control is also linked to health because the level of control we have over our lives is closely related to the other social determinants of health. For example, a group of people who have come together and taken action over an issue (such as housing conditions) collectively can influence other social determinants of health positively by taking control.

“People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health.” World Health Organisation, Ottawa Charter for Health Promotion.

Examples of how funded partners are fostering individual and collective control 

Find out more about collective control

Our surroundings

Our local surroundings have an impact on our health by enabling healthy living and a safe environment. Having an accessible green space; community space; safe, well-lit roads and good air quality helps enable people to build social connections, access services and be physically active. Access and proximity to green space are unequally distributed across the population. The most affluent 20% of neighbourhoods in England have five times the amount of green space compared with the most disadvantaged 10% of neighbourhoods. [1]

Taking action to improve our local surroundings also brings other benefits through building confidence and skills and strengthening local control.

Examples of how funded partners are improving their surroundings locally 

Find out more about how our surroundings are a social determinant of health from our partner The Health Foundation


[1] CABE. Urban green nation: Building the evidence base. London: CABE; 2010.

Jobs and income

Having good working conditions, fair contractual conditions, and stable employment that pays at least the real Living Wage all have a big impact on our health.

People need sufficient income to live healthily, including being able to buy quality affordable food. There is also a strong link between the level of control we have in our work and our health. Access to affordable and reliable public transport is also an important factor in facilitating our ability to find jobs and increase our income.

Conversely, being out of work or being in low-paid employment has a significant and long-term negative impact on your health and your wellbeing. The welfare system also has a big impact and benefit sanctions can be particularly detrimental. 

“The Living Wage means for me that I get to enjoy a better quality of life not just for me but also for my family. I also feel that my employers really value me and the work that I’m doing.” Rehana Begum, Centre Manager for Aspire and Succeed, Local Conversation in Lozells

How funded partners are supporting jobs and income in local communities 

Find out more about the Living Wage and health inequalities

Local economies 

The places in which we live have a huge impact on our health. This includes how money flows locally to ensure what is invested re-circulates and contributes to local wealth building. A thriving local economy can include locally owned community assets and shops with affordable, healthy food; access to quality jobs that pay at least the real Living Wage with opportunities to build skills, and the distribution of wealth more equitably within local communities.

How funded partners are supporting strong local economies 

Find out more about local economies 

Housing

The conditions in which we live have a big impact on our health. Problems with housing include physical problems such as damp, cold and overcrowding, as well as issues of instability, temporary housing and rising costs. Housing issues often lead to people feeling powerless and isolated. Costs and eviction fears have an impact on people’s health and wellbeing, as well as preventing people from raising issues and speaking out. Being homeless has a negative impact on someone’s health. It makes it difficult to access health and support services and reduces life expectancy by up to 38 years.

“One of the big issues is poor quality housing. We have many children who have asthma problems, breathing, respiratory problems. When we talk to parents, it turns out that they are living in damp conditions, they’re paying rent to a landlord, and the issues aren’t being dealt with appropriately.” Local Conversations in Lozells

How funded partners are addressing local housing issues

Find out more about housing as a social determinant of health

Education and skills

Education, skills and training are critical for people to develop supportive social connections; access good work; develop an aptitude for life-long learning and problem solving, and to feel empowered, valued  and have control over their lives. As people build their skills, they also build their confidence. There is a large body of evidence which strongly and consistently links education with health, even when other factors like income are taken into account.[1]

Evidence from our evaluations and project reports shows that people with active roles have gained skills in communicating, influencing and negotiating with other organisations.

"People really want to learn. We’re trying to help people build the skills they need to live a happy life, to support their families, get to know their neighbours and make friends in the community.” Phoebe Cullingworth, Development Manager at EFA London (Active Communites 2018-2020) 

Examples of how our funded partners are supporting education and skills in local communities

Find out more about education and skills as social determinants of health. 

 


[1]Robert Wood Johnson Foundation's Education and Health report (2011).

 

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