The determinants of health encompass all non-medical factors that shape the health status of an individual or a population. Their impact far exceeds that of the healthcare system: conditions of birth, work environment, level of education, and social cohesion directly modify life expectancy and quality of life. This article details twelve concrete factors, along with the available data on their respective impacts.
1. Income Level and Wealth Distribution
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Income determines access to housing, quality food, and leisure activities. The WHO emphasizes that the life expectancy gap between countries can sometimes reach 33 years, a divide largely correlated with economic disparities.
Within the same country, available data often reveal a widening gap between social groups. According to the WHO, eliminating wealth-related inequalities in low- or middle-income countries could save a considerable number of lives each year, particularly among children.
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To understand health determinants in their entirety, income remains the foundation upon which most other factors rely or weaken.
2. Education Level and Health Literacy
The WHO indicates that people with a higher level of education live longer and are healthier than those with a lower level of schooling. This gradient is observed in nearly all documented countries.
Education acts through several channels: better understanding of prevention messages, access to jobs less exposed to physical risks, and an increased ability to navigate the healthcare system. Health literacy, meaning the ability to find, understand, and use health information, extends this effect well beyond formal schooling.
3. Working Conditions and Psychosocial Risks
The European Agency for Safety and Health at Work (EU-OSHA) links psychosocial risks to the design, organization, and management of work. Their effects are both psychological, physical, and social: anxiety, musculoskeletal disorders, isolation.
Mental health at work is treated as a full-fledged health determinant, rather than just a simple occupational risk. Prolonged exposure to excessive workload or lack of decision-making autonomy increases the risk of cardiovascular diseases and depression.
4. Physical Environment and Housing Quality
Indoor air, humidity, exposure to noise, or proximity to pollution sources directly alter respiratory and cardiovascular health. The CDC classifies these daily living conditions among the most tangible structural determinants.
The ISADORA initiative, supported by French communities, aims to integrate health into urban planning operations. The goal: to act upstream on housing and public space rather than addressing health consequences downstream.
5. Effective Access to Healthcare Services
Public Health France emphasizes that social health inequalities also stem from an unequal distribution of access to services. Geographic distance, financial out-of-pocket costs, and appointment wait times constitute three measurable barriers.
In France, the Regionalized Human Development Index (IDH-2) used by ARS Île-de-France allows for observing social and territorial health inequalities on a fine scale. This type of recent territorial tool goes beyond just healthcare provision to intersect social and health indicators.
6. Social Cohesion and Sense of Belonging
An analysis published in 2024 in the Journal of the Progressive reports that a low sense of community belonging is associated with poorer self-rated health, after adjusting for several confounding factors.
Social cohesion acts as a buffer against stress. Support networks, neighborhood help, and associative participation reduce isolation, a documented factor of excess mortality among the elderly.
7. Nutrition and Food Security
Access to a varied and nutritious diet depends on income, proximity to stores, and food literacy. In so-called “food desert” areas, the offerings often limit to ultra-processed products, high in caloric density and low in nutritional density.
Food security is not limited to the quantity available: it encompasses the quality, regularity, and cultural appropriateness of accessible foods. This factor heavily influences the prevalence of type 2 diabetes and obesity.
8. Economic Policies and Social Norms
The CDC now distinguishes daily living conditions from broader forces and systems that shape them. Economic policies, social norms, structural racism, and political structures constitute these so-called “upstream” determinants.
Acting on these levers requires decisions that extend beyond the scope of the Ministry of Health: fiscal policy, labor law, urban planning, educational policy. The WHO refers to “health in all policies” to describe this cross-cutting approach.
9. Genetic Heritage and Individual Biology
Genetic predisposition to certain diseases (cancers, cardiovascular diseases, diabetes) constitutes a determinant over which the individual has no direct control. The model by Marc Lalonde, formulated in Canada in the 1970s, already placed human biology among the four major categories of determinants.
However, the expression of these predispositions strongly depends on the environment and behaviors. Genetic heritage interacts with other determinants rather than acting alone.
10. Individual Health-Related Behaviors
Smoking, alcohol consumption, sedentary lifestyle, and risky practices fall under individual behaviors. These lifestyle habits are, however, shaped by the social context: stress levels, peer group norms, accessibility of sports facilities.
Effective prevention policies therefore target both behavior and the environment that makes it possible. Banning tobacco advertising, taxing sugary drinks, or creating bike lanes alters the conditions under which individual choices are made.
11. Social Support Networks and Family Ties
Social support is distinguished from community cohesion by its interpersonal nature: presence of a partner, stable family relationships, friends available in times of difficulty. These ties protect against depression and promote adherence to treatments.
Socially isolated individuals have an increased risk of mortality from all causes. This finding holds regardless of income or education level, making it an autonomous determinant.
12. Climate Change and Global Environmental Determinants
The CDC now incorporates climate change among the systemic forces that shape population health. Heatwaves, extreme weather events, migration of infectious disease vectors: the health effects of climate disruption primarily affect already vulnerable populations.
This determinant amplifies existing inequalities. Low-income populations have fewer resources to adapt (air conditioning, relocation, access to drinking water), creating a cycle of cumulative vulnerability.
These twelve factors never operate in isolation. Income conditions diet, education modifies behaviors, and climate exacerbates pre-existing vulnerabilities. The most recent public health approaches, such as the regionalized IDH-2 or the ISADORA initiative, specifically attempt to intersect these dimensions to target interventions where multiple determinants converge.