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The three-headed hydra of apathy, envy and fear would prefer you not ask too many questions.

What are the social determinants of health? The three-headed hydras would prefer you not ask.


This twenty-part series introduces you to twenty key terms used in a local mobilizing process that you and your community will require to survive and thrive during colliding crises. The articles will reference the three-headed hydras of apathy, envy and fear, those people in positions of power who are fighting to keep a broken status quo.

Concept 4: social determinants of health

Social: so·cial

adjective. relating to society or its organization.
“alcoholism is recognized as a major social problem”

Determinant: de·ter·mi·nant

noun. a factor which decisively affects the nature or outcome of something. “pure force of will was the main determinant of his success”


noun. the state of being free from illness or injury.
“he was restored to health”

How might we define the social determinants of health?

If you have a spare weekend, explore all the definitions of health. Searching the definition of health, about 2,230,000,000 results appear in 0.52 seconds. According to the World Health Organization’s website:

health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

We can go with that for now and follow up with asking what and who determines our health.

The answer can be found by exploring a concept called the social determinants of health.

The social determinants of health are elements (people, services, resources) people have access to in childhood. It’s a fascinating and sometimes complex field of study that explores how a person’s community environment can impact his or her health and opportunities for learning, work and wealth. To translate many decades of research into one phrase, if we grow up with access to helpful services and resources, we do much better in life than if we don’t. As we delve into the social determinants we encounter concepts like health equity and health disparities.

To be less abstract, the social determinants of health could be considered the ten vital services for surviving and thriving. Through a survey of residents, we can determine to what degree their health improved because they had easy access to medical, dental and mental health care, along with stable food and secure housing (thanks to food and housing security programs) and transport to all vital services.

I should mention that there are those who would prefer you not think too deeply about what or who determines the health and safety of your neighbors or families on the other side of town. To defy the wishes of the three-headed hydras, read on.

10 social determinants of health: One definition

The World Health Organization has identified 10 social determinants of health:

  • the social gradient
  • stress
  • early life
  • social exclusion
  • work
  • unemployment
  • social support
  • addiction
  • food
  • transport

Of these 10, the single strongest predictor of our health and well-being is our position on the social gradient (or the ‘social ladder’). Whether measured by income, education, place of residence or occupation, those people at the top of the gradient have the most power and resources, and on average live longer and healthier lives. Those people at the bottom have the least power and usually run at least twice the risk of serious illness and premature death as those near the top.

Five Categories for the Social Determinants of Health: Yet another definition

The US Centers for Disease Control and Preventions website offers this:

Health is influenced by many factors, which may generally be organized into five broad categories known as determinants of health: genetics, behavior, environmental and physical influences, medical care and social factors. These five categories are interconnected. The fifth category (social factors or social determinants of health) encompasses economic and social conditions that influence the health of people and communities. All of these factors (social determinants) impact the health and well-being of people and the communities they interact with.

Six factors related to the social determinants of health and tied to services

I took a look at the CDC’s list of several factors related to health outcomes and did some edits and embellishments. See below a list of seven (and it could be a much longer list).

  1. How a person develops during the first few years of life (access to early childhood development which can be greatly enhanced with access to quality early childhood learning programs)
  2. How much education a person obtains and the quality of that education (access to higher education and vocational education)
  3. Being able to get and keep a job, what kind of work a person does and how much money a person earns (individual income and household income)
  4. Having food or being able to get food (access to food security programs)
  5. Having access to health services and the quality of those services (access to medical, dental and mental health care)
  6. Living conditions such as housing status, public safety, clean water and pollution (access to housing security programs)

One Factor (or social determinant of health) is tied to Technology

Access to current and emerging technologies impacts our health, education and economic opportunities in many ways. Mobile devices, computers and the internet makes web-based education, online services, job training, placement and the capacity to work from home online possible. Without easy access to the net, you are on the punishing side of the digital divide.

Who determines the social determinants of health? (hint: heroes and hydras)

Not unlike the definitions of social adversity, one can read tons of definitions and never once read that it is people, humans in positions of power, who maintain the living environments that lack vital resources.

We, meaning the elected leaders of your county, determine to what degree county residents have access to the services and resources to be healthy.

While some communities are awash in accessible services, in others we doom people to poor health outcomes with man-made strategies. It’s human ingenuity, compassion and a strong sense of social justice that will reverse this.

To be clear, through action or inaction on the part of elected leaders (and those who support them and work for them), we are either empowering people or diminishing them.

The social determinants of health are measurable and that is what we can do, county by county. The mission of a civilized society is to survey residents to understand their access to services and then increase vital services so that 100% of residents may access them.

We can’t save the world or the nation yet we all have the power to be engaged in a local process that ensures every community within one’s county borders is well-resourced. What determines the quality of life for our most vulnerable populations is determined by caring people like you. If you don’t step up, the three-headed hydras, who rejoice at keeping people down, will.

Suggested reading: 100% Community, Chapter 5: The Root Causes of a Host of Health Challenges

The future is what we make it. Join the evolution.

Please excuse any typos as I construct an article at 3am on only one cup of Joe. These stories are mine and mine alone. I do not represent any organization here. If one of my illustrations looks like a real human or three-headed hydra, that’s total coincidence. Words and images ©Dominic Cappello but share with everyone you know. The future awaits:

A NY Times bestselling author, social justice activist, Oprah guest, co-author of Attack of the Three-Headed Hydras, 100% Community and Anna, Age Eight.

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