"Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue." (Professor Sir Michael Marmot)
This document has been peer-reviewed by Fellows of the RACP to help you find high-quality CPD resources on the social determinants of health.
Resources are categorised by type:
Key Organisations and Websites
Tools and Action
- Policy and Advocacy
- Key Journals
- Recommended Reading
Learn about the social determinants of health
The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries. There is ample evidence that social factors, including education, employment status, income level, gender and ethnicity have a marked influence on how healthy a person is.
In all countries – whether low-, middle- or high-income – there are wide disparities in the health status of different social groups. The lower an individual’s socio-economic position, the higher their risk of poor health, therefore health inequities are systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies. Physicians who can identify social determinants of health in their patients, communities and populations are in a unique position to be able to influence and manage these factors to deliver better health outcomes.
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1. Key Organisations and Websites
Useful as a starting point and overview of current work in this
CPD TIP: Keep notes on your activities on these sites to claim CPD points in Category 5 (1 credit/hr).
Useful for brief overviews of topics and recent developments
CPD tip: Keep notes on the activities you watch or listen to to claim CPD points in Category 5 (1 credit/hr).
'Fair Australia: Social Justice and the Health Gap'
In these ABC podcasts, Professor Sir Michael Marmot discusses the intertwined causes and challenges in addressing health inequalities and inequities:
'What Causes Wellness?'
Sir Harry Burns explores the notion of salutogenesis as opposed to the one of pathogenesis. He looks at the impact it has on the most disadvantaged members of our community.
'How Economic Inequality Harms Societies'
Professor Emeritus Richard Wilkinson examines economic data and discusses some of the inequalities that occur when the gap between rich and poor widens. He looks at how different societies manage social and economic factors and charts the differences on health, lifespan, values and trust.
The Social Determinants of Health
This video from the University of British Columbia explores the many factors such as income, education, transportation, housing, and race or ethnicity, that interfere with health equity and the ability of patients to get their health care needs met.
Q&A – Social Determinants of Health
This panel discusses the future of the ‘Fair Go’. The topics include discussions on taxation, income support, health and welfare, poverty and closing the education wealth gap.
RACP Congress 2017 – Closing Plenary
Sir Michael Marmot addresses the crowd during the final sessions of the RACP Congress 2017 with the closing plenary titled 'Doctors must do more to change the world – employment, poverty and health.'
Talking About Social Determinants
The Australian Psychological Society has put together a series of videos with psychologists discussing the importance of understanding patients’ social determinants and their impact on both patients’ mental and physical health.
3. Tools and Action
Useful for in depth, structured learning
CPD tip: Keep documentation from audits to claim CPD points in Category 1 (3 credits/hr).
This planning tool for health promotion policy and practice was produced by VICHealth. It provides entry points for action to reduce health inequities.
Four Steps Towards Equity – A Tool for Health Promotion Practice
This framework was developed as a part of the NSW Health Promotion Directors Equity Project as a tool for better health practice.
Cultural Competency Questionnaire:
The RACP has developed a cultural competence questionnaire for physicians in both Australia and New Zealand to assess and reflect upon their behaviours within their practice in regards to cultural sensitivity.
Goulbourn Valley Health Social Determinants
Goulbourn Valley Health has compiled a list of statistical resources providing data on variables that have an impact on health. They provide socio-economic indexes for specific areas as well as housing and gambling data for areas within Australia. Understanding these variables within the community of your practice will help you inform and address your patients’ determinants of health.
Patient Centred Care Framework
The RACP’s Framework for Patient Centred Care (PCC) is an approach to the planning, delivery, and evaluation of health care that treats the whole patient (experiences and lifestyle included) rather than simply the disease. This document outlines the key domains of PCC, its importance, goals and principles.
Guidelines on Māori Cultural Competencies for Providers
These guidelines have been developed to assist healthcare providers in improving access and delivering appropriate advice, care and treatment to Māori clients. It includes sections about the impact of culture on health as well as guidance in addressing cultural preferences appropriately at the individual-practitioner level.
Public Health Advocacy Institute of WA Toolkit
This toolkit is a how-to guide for health practitioners wishing to get more involved in public health advocacy. It explains what advocacy is, provides case studies and tools to get started down the advocacy pathway.
Health Leads Screening Toolkit
The Health Leads Screening Toolkit is designed to assist health care professionals screen their patients for social needs that impact upon their health. It includes social needs domains, best screening practices, sample screening tools, and a questions library. It combines a patient-centred approach with clinically validated guidelines.
Social Determinants of Health Case Study
This case study, taken from the textbook Professional and Therapeutic Communication (ISBN: 9780195591064), is designed to help you think about the social determinants of health in the context of an individual patient, as well as provide additional questions to provoke thinking and understanding. Copyright Oxford University Press, reproduced with permission.
Useful for in-depth, structured learning
CPD tip: Keep certificates and notes from courses to claim CPD points in Category 3 (1 credit/hr).
Cultural Competence and Indigenous Health E-Learning Courses
The RACP has developed several courses on Cultural Competence and Indigenous health. Participants who undertake these courses learn about the cultural determinants of Indigenous health and how to apply this in practice to ensure high quality healthcare.
Future Learn: Financial Inequalities and Their Impact
This online course explores the determinants of wealth and its impact on income inequality throughout the world. It will delve into social and political changes that have influenced income inequality and what individuals, communities and government can do to take action.
University of New South Wales: Inequalities and Health
This course offered by the University of New South Wales is designed to introduce and explore the practical issues in addressing health inequalities in Western industrialised countries. (Typically offered in the summer semester.)
Diagnosing Health Behaviours for Global Health Problems
John Hopkins University has developed an online course to teach the various behaviour models and practical frameworks to understand, analyse and influence behaviour change for successful public health interventions.
Community Change in Public Health
This online course developed by John Hopkins University focuses on the community changes necessary to promote public health. It examines the different levels of involvement and sustainability of an intervention within a community.
Health for All Through Primary Health Care
This online course, developed by John Hopkins University, is designed to emphasise and explore the importance of primary health care in achieving health for all. It provides some real-world examples of how primary health care has been implemented and some cost-effective approaches to apply in your own community.
Open Universities Social Determinants of Health
This online course is designed to test and expand common beliefs about the social and cultural influences on health. It will provide theories and frameworks that will help you to become aware and interpret various life concerns both personally and professionally.
5. Policy and Advocacy
Useful for understanding the professional response to critical health issues
CPD tip: Keep notes on what you read to claim CPD points in Category 5 (1 credit/hr).
Health in All Policies Position Statement
The position statement provides an overview of what HiAP entails, how this approach to policy making can impact the social determinants of health, and the role of health professionals in advocating for public policy that takes a HiAP approach. It also highlights practical strategies to positively influence the social determinants of health and their impacts on patients.
AFOEM Position Statement: Realising the Health Benefits of Work - 2011
This position statement is the second in a series of position statements exploring work and health, developed by the Faculty of Occupational and Environmental Medicine. The first position statement explores an evidence based approach to assisting people to stay in work or return to work.
AFOEM Position Statement: Improving workforce health and workplace productivity - A virtuous circle - 2013
This position paper advocates that health is a fundamental issue in Australia and New Zealand, embraced by government and citizens. However, the role of health in the workplace has not yet been established as a fundamental principle on which to create and develop workplace culture. This position statement is supported by a sister position statement that outlines the nature of ‘good work’.
AFOEM Position Statement: What is Good Work? 2013
This document is intended for those who want a contextual understanding of 'good work' so that they can facilitate putting the evidence into practice. It is a companion statement to the New Zealand and Australian Consensus Statements concerning the Health Benefits of Work and the RACP’s original Position Statement, Realising the Health Benefits of Work (although the views in this paper are those of the RACP). This position statement is supported by a sister position statement that outlines the links between workplace health and workplace productivity.
AFOEM Realising the Health Benefits of Work – An Evidence Update - 2015
This update documents emerging evidence for the effect a lack of ‘good work' has on mental health. It highlights the need for promoting recovery at work practices, and better integration between health services and employers.
6. Key Journals
Useful for keeping up to date with research and finding out more on
CPD tip: Keep notes on what you read to claim CPD points in Category 5 (1 credit/hr).
Journal of Urban Health
Journal of Urban Health is an authoritative and balanced information source to advance urban population health and well-being. The resources include primary data, book reviews, editorials, commentaries, case studies and reports. It aims to link scholars, practitioners and policy makers to debate and improve urban health policies, programs, and governance.
International Journal for Equity in Health
This journal aims to improve the understanding of issues that influence the health of populations, including political, policy, economic, social and health service related influences.
International Journal of Epidemiology
International Journal of Epidemiology publishes resources on global epidemiological advances and new developments. Its objective is to promote multidisciplinary dialogue among researchers, teachers and social and preventive medicine practitioners.
Journal of Epidemiology and Community Health
This journal focuses on epidemiological knowledge and improvement of global health.
Sociology of Health and Illness
A range of issues on sociology, illness, medicine, health and health care are covered in this international journal. Working in association with the Foundation for the Sociology of Health & Illness, the journal aims at encouraging debate, social scientific research and education worldwide.
Journal of Health Economics
The journal’s prime focus is economics of health and medical care. Its outlook is on both developed and less developed countries. The research published is on health services including demand, supply and financing of services, determinants of health and the economics of ill-health and behavioural models of health care agencies.
7. Recommended Readings
Useful for finding out more on
CPD tip: Keep notes on what you read to claim CPD points in Category 5 (1 credit/hr).
Fair Society, Healthy Lives
The Marmot Review proposes an effective evidence-based strategy for reducing health inequalities in England.
The Social Determinants of Health: the Australian Perspective
A transcript of the AMA President A/Prof A Brian Owler’s speech 'The role of physicians and national medical associations in addressing the social determinants of health and increasing health equity’, BMA Symposium London 2015.
The Social Determinants of Health: It's Time to Consider the Causes of the Causes
This article reviews some of the knowledge accumulated to date that highlights the importance of social—and particularly socioeconomic—factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects.
Effective Action by Physicians on the Social Determinants of Health
This article, written by the College of Family Physicians in Canada, provides a comprehensive look into the barriers physicians face incorporating the social determinants of health into the management of their patients’ health as well as some practical tools to start focusing on the social determinants of health.
Contextual Errors and Failures in Individualizing Patient Care: A Multicentre Study
This article investigates the frequency and circumstances under which physicians probe contextual and biomedical red flags and avoid treatment error by incorporating what they learn from these probes.
An Evidence-Based Patient-Centred Method Makes the Biopsychosocial Model Scientific
This article is a review of the biopsychosocial model and investigates ways to improve it and implement it in practice.
For Richer for Poorer, in Sickness and in Health
This booklet, developed by the RACP, is designed to be a tool to generate debate in the health policy arena and general public. It includes details on the key socio-economic determinants of health and suggests ways in which health professionals, community workers, educators, the government and the general public can work together in policy and program development to make positive changes in this area.
The Value of Occupational Health
This report synthesises the evidence from the scientific and wider literature to help illustrate and publicise the benefits that occupational health services provide to employers, workers and to the economy.
European Strategies for Tackling Social Inequities in Health
This report presents the latest evidence about the nature and extent of the problem of social inequities in Europe. It provides an approach and policy options to tackle social inequity and how to develop strategies for tackling social inequities in health.
Closing the Gap – Prime Minister’s Report 2017
This report looks at the progresses and the challenges made in addressing closing the gap between Indigenous and Torres Strait Islanders and non-indigenous Australians.
The Cost of Inaction on the Social Determinants of Health
This finding from NATSEM – University of Canberra confirms that the cost of government inaction on the social determinants of health leading to health inequalities for the most disadvantaged Australians of working age is substantial. It looks at the effects on the overall well-being, the ability to participate in the workforce, the reliance on government income support and the use of health services.
Educating Health Professionals to Address the Social Determinants of Health
National Academies of Sciences, Engineering, and Medicine convened a workshop to develop a high-level framework for health professional education. A Framework for Educating Health Professionals to Address the Social Determinants of Health was put forth with the goal of helping stakeholder groups envision ways in which organisations, education, and communities can come together to address health inequalities.
Indicators of Inequality for Māori and Pacific People
This study investigates a number of inequality indicators in New Zealand. The research examines the current gaps in the indicators between the European population and Māori and Pacific people. The study also undertakes a comparison of the changes in the gaps over a period approximating 10 years for each of the indicators.
Action on Social Determinants of Health: Case Studies from Australia
This book was developed following the World Conference on Social Determinants of Health in 2011 with the aim of sharing some of the experiences of Australian jurisdictions of acting on the social determinants of health in the lead up to the 8th Global Conference on Health Promotion in Helsinki, Finland.
Beyond the Evidence-Based Policy in Public Health
Smith, K. Beyond Evidence-based Policy in Public Health: The Interplay of Ideas [Internet]. Basingstoke (UK): Palgrave Macmillan; 2013. ISBN 978-1-137-02657-6.
Health Inequalities – Critical Perspectives
Smith K, Bambra C, Hill S. Health Inequalities : Critical Perspectives [Internet]. Oxford (UK): Oxford University Press; 2016. ISBN: 9780198703358.
The Health Gap – Improving Health in an Unequal World
Marmot, M. The Health Gap: The Challenge of an Unequal World [Internet]. 1st ed. London (GB); Bloomsbury Publishing; 2016. ISBN: 9781408857977.
The Spirit Level – Why Equality is Better for Everyone
Picket K, Wilkinson R. The Spirit Level - Why Equality is Better for Everyone [Internet].2nd ed. London (GB): Penguin Books Ltd. 2010. ISBN-10: 0241954290.
Social Determinants of Health: The Solid Facts
Wilkinson R, Marmot M. Social determinants of health: the solid facts [Internet]. 2nd ed. Copenhagen (Denmark): World Health Organisation; 2003. ISBN 92 890 1371 0.
A Sociological Approach to Health Determinants
Schofield T. A sociological approach to health determinants [Internet]. 1st ed. Port Melbourne (Australia): Cambridge University Press; 2015. ISBN: 9781316277287
The New Public Health
Baum, F. The New Public Health. 4th ed. Australia: Oxford University Press; 2015. ISBN 9780195588088.
Social Causes of Health and Diseases
Cockerham W. Social Cause of Health and Disease [Internet]. 2nd ed. John Wiley & Sons; 2014. ISBN: 978-0-745-66120-9.
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