Social Determinants of Health

The ideation of poverty and its relationship to health inequalities and inequities is in part a valid assessment but, poverty is not necessarily the underlying primary precursors of health inequalities and inequities in a society. Population-focused determinants of societal health are more complicated than a mere function of poverty (Cohen, Chavez, & Chehimi, 2012). The ramification between societal-health comprises of multifactorial variables or risk factors (Cohen, Chavez, & Chehimi, 2012). Income inequality and social disparity are factors attributable to health inequalities in population health (Wilkinson, & Pickett, 2010). Interestingly, income inequality does not necessarily equate to the differences in the national income per person. Its modality in part, refers to income gap within a societal class, social structures and socio-economic status, etc. (Wilkinson, & Pickett, 2010). Hence, to assess the impacts of income inequality and social disparity on health inequalities within a target population, an inter-regional health comparison between a wealthy and poor nation is necessary. Therefore, using this social determinant construct, population health comparison between Cuba, US, Japan and Norway are necessary and perhaps sufficient comparison in shading lights on the issue of health disparity within the target population.

Considerably, the US and Norway had the highest national income per person, in the world (Wilkinson, & Pickett, 2010). Also, the US and Norway are economically developed than Cuba. More importantly, the US national income per person is more than four times greater than the national income per person in Cuba. In furtherance, Cuba is considerably a poor and developing nation. Nonetheless, the life expectancy in Cuba is higher than that of the US, which is about 79 and 78 years respectively (Wilkinson, & Pickett, 2010). Norway and the US have similar national income per person index, yet, the life expectancy in Norway is about 81 years (Wilkinson, & Pickett, 2010). On the other hand, Japan’s life expectancy is 83 years even when the national income per person in Japan is about 25% less than the US and Norway’s income per capita (Wilkinson, & Pickett, 2010).

The simple explanation for the life expectancy difference is partly associated with the intra-income gap within each nation (Wilkinson, & Pickett, 2010). In contrast, the inter-income gap or disparity between countries such as Cuba/Japan vs. the US do not seem to impact life expectancy. Therefore, it is a fair assessment to indicate that a country could be considerably poor compared to other nations and yet attain a meaningful and sustainable healthy social system. Cuba is an example whereby the introduction of an accessible and equitable universal Salud (Health) system among other things, such as standard public health infrastructures/infostructures are necessary and sufficient in mitigating health disparity in the country. Apparently, Cuba health care system is much better than many developed countries in the world.

One of the misconception and challenge of the traditional approach for assessing population health is the assumption that increasing the standard of living or increasing the average income per person alone will inherently increase the quality of life and mitigate persisting social inequalities. The assumption is far from reality. The social structure of Cuba and Japan’s economic per capita are examples that suggested otherwise. The social structure modalities in Japan indicated that closing the gap between income and social inequality is rather one of the solutions to mitigate health inequalities and inequities rather than increasing the income level alone (Wilkinson, & Pickett, 2010).

The use of social and population determinants to measure population health is essential because different population characteristic profiles uniquely incorporate various levels of social impacts, racial diversities and cultural values, etc. within the target population social structures. As a result, understanding the population determinants associated with societal health are invaluable assets to creating a healthier society and sustainable population health intervention system. For instance, Japanese see themselves as self-deprecating and self-critical in presenting themselves in terms of social esteem and self-esteem (Wilkinson, & Pickett, 2010). In contrast, Americans attribute individual success to ones’ ability, and then failures to external factors (Wilkinson, & Pickett, 2010). On the other hand, Japanese tend to assert their success as a function of luck than of judgment while suggesting failures to ones’ lack of ability (Wilkinson, & Pickett, 2010). Interestingly, social ideology of perceived self-perception and social perception revolve around the ideation of “social-evaluation threat,” which is the common denominational root of social mobility, self-esteem, pride, shame and social insecurity (Wilkinson, & Pickett, 2010). Perhaps, it is clear that the increase of anxiety and depression in developed countries have been accompanied by the increase in unhealthy-self-esteem/insecure high self-esteem (narcissism and threatened-egotism), which is associated with many adverse health outcomes in the society (Wilkinson, & Pickett, 2010).

Unfortunately, when the social structures in any nation is not fairly balanced but rather encourages and promotes individualism disproportionately against community and social well-being; the social justice system, public health structures, and social well-being determinants weighs heavily and disproportionately on those lower in the social ladder. For instance, public health funding for many social and community works have been drastically cut and left dysfunctional (Parker, & Thorson, 2009). By nature, within a functional or dysfunctional society, a person’s identity is embedded in the community to which the individual belongs. Peoples’ knowledge of each other, familiar faces, closely connected family and kinsmanship (kins-personship) are part of the social identity (Wilkinson, & Pickett, 2010).

Sadly, when the social structures drift towards the anonymity of “mass society”, the social consequences result in an endlessly open-ended questioning of “who we are” and “identity” itself (Wilkinson, & Pickett, 2010). A “mass society” is a modern era “society” whereby a mass culture, large-scale, impersonal, and social structures are imposed on the social systems (Wilkinson, & Pickett, 2010). It is a society whereby individualism, prosperity, and bureaucracy deteriorates the conventional or traditional “social ties” or relationships (Wilkinson, & Pickett, 2010). Such society also lacks emotional intelligence. Therefore, to establish a sustainable social reform and real egalitarian society, there must be a sense of balance between a capitalistic structural system and social structures (Herbes-Sommers, & Smith, 2008; Laureate Education, 2011; WHO, 2008). Perhaps finding the right healthy-social structural balance will mitigate the issues of health inequalities, health inequities and other social problems, globally.


Cohen, L., Chavez, V.,&  Chehimi, S. (2012). Prevention is Primary. Strategies for community well-being. (2nd ed.). San Francisco, CA: Jossey-Bass.

Herbes-Sommers, C., & Smith, L.M. (2008). Health in America. Retrieved from Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_ 5554359_1%26url%3D

Laureate Education. (2011). Determinants of population health. Retrieved from s/portal/frameset.jsp?tab_tab_group_id=_2_1 &url=%2Fwebapps%2Fblackboard%2 Fexecute%2Flauncher%3Ftype%3DC ourse%26id%3D_5554359_1%26url%3D

Parker, J. C., & Thorson, E. (Eds.). (2009). Health communication in the new media landscape. New York, NY: Springer Publishing Company.

Wilkinson, R., & Pickett, K. (2010). The spirit level: Why greater equality makes societies stronger. New York, NY: Bloomsbury Press.

World Health Organization (WHO). (2008). Commission on the social determinants of health. Retrieved from ?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2 Fexecute%2Flauncher %3Ftype%3DCourse%26id%3D_ 5554359_1%26url%3D