The Determinants of Health: Social, Structural, and Political Contributions to Health-Related Outcomes

The Determinants of Health: Social, Structural, and Political Contributions to Health-Related Outcomes

Molly Jacobs (East Carolina University, USA), Fatima Jebahi (East Carolina University, USA), and Charles Ellis (East Carolina University, USA)
DOI: 10.4018/978-1-7998-7134-7.ch003
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The determinants of health have received substantial attention in the medical literature as recent evidence has shown that they play in vital role in general health and health-related outcomes. Despite the advancing literature, the field of communication sciences and disorders (CSD) has been slow in the both the consideration of the determinants of health as well as the measurement of commonly known determinants believed to influence clinical outcomes. The goal of this chapter is to explore the determinants of health and potential relationship to the study of communication disorders and the outcomes being measured.
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Health is a state of complete mental, social and physical well-being, not merely the absence of disease or infirmity.” – World Health Organization, 1948



Good health hinges on a complex array of genetic and environmental factors some of which are beyond the control of the individual. Although beyond the individual’s total control, the presence of good health allows one to live long and fulfilled lives. Yet many individuals do not consistently experience good health thereby resulting in disparities in health and health-related outcomes. Longstanding, health disparities remain a major health-related issue in the US. The synergistic effects of well-established social, structural and political systems (determinants) underlie many of the health disparities that exist worldwide. To date little, if any, consideration has been given to the contribution these same determinants have made to outcomes in the field of communication sciences and disorders (CSD) and the disciplines of speech-language pathology and audiology (SLP/Aud). More specifically, little is known about how the determinants of health impact disparities in rehabilitative outcomes in fields like CSD. This chapter will explore the determinants of health in general and establish a link to the field of CSD to identify strategies to close the disparity gap in health-related outcomes that currently exists in the field. The goal of this chapter is to introduce CSD researchers and clinicians to the determinants of health that drive health disparities and negatively impact clinical outcomes in the field. Traditionally research and clinical practice patterns in the field of CSD emphasize clinical measurement approaches that do not consider the impact of social and structural determinants of health on clinical outcomes. The chapter will conclude with a summary of strategies that have been utilized in other fields to reduce the impact of the determinants of health that might be considered in the field of CSD.

Key Terms in this Chapter

Vulnerable Populations: Population groups that are at greater risk for poorer health, less healthcare access and who experience disparities in life expectancy.

Political Determinants of Health: The implications of politics and policy that influence the social conditions in which people live and the health outcomes they experience.

Privilege: Instances where one population group has something of value that others are denied simply based on the population groups they belong to.

Social Determinants of Health: The life circumstances in which people are born, grow, live, work, and age over time.

Healthcare Disparities: Differences in access to or availability of healthcare services between population groups that are influenced by such factors as socioeconomic status, race/ethnicity, or sex/gender.

Health Disparities: Higher burden of illness, injury, disability experienced by one group of individuals relative to another.

Structural Determinants of Health: The root causes of health disparities which include governing processes and economic/social policies that affect income, working conditions, housing, and education, among others.

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