By Jean Baptiste Ndabananiye
“Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact,” states the World Health Organization [WHO] with its 4 October 2024 article entitled “Determinants of health”.
The determinants of health, according to the WHO, involve the social and economic environment, the physical environment, and the person’s individual characteristics and behaviors. “The context of people’s lives determine[s] their health, and so blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health. These determinants—or things that make people healthy or not—include the above factors, and many others.”
“The more commonly considered factors often have less of an impact.” Why?
Food constitutes a crucial factor of health, but this truth rarely comes consciously to people’s minds. People tend to recall and value what they are most aware of. Consequently, access to and use of health-care services—despite their relatively smaller impact compared with other determinants—are often regarded as more significant, because their role in treating illness stands more visible and immediately recognizable.
People generally overrate the importance of medical care because they are more consciously aware of it, while the fundamental determinants of health such as food operate quietly in the background. You will automatically recall a thing, when you are fully aware of it- this represents the reason behind.
PubMed Central (PMC) constitutes a free digital archive of biomedical and life-science journal literature maintained by the National Center for Biotechnology Information (NCBI) under the U.S. National Library of Medicine (NLM). The NLM operates within the National Institutes of Health (NIH), the primary agency of the United States government responsible for biomedical and public health research. The U.S. National Library of Medicine also forms the world’s largest medical library.
The platform contains an 11 February 2014 piece of writing entitled “The imperative for health promotion in universal health coverage”. This thorough piece corroborates the point that societies still invest more attention and resources in health services, partly because treatment is more visible and immediate. “Why prevention gets little attention. Prevention all too often gets little attention, despite being culturally ingrained, as typified by Benjamin Franklin’s proverb ‘an ounce of prevention is worth a pound of cure,’ and although it is often highly effective and cost-effective.
Harvey Fineberg, President of the Institute of Medicine, suggests that among these reasons are: the success of prevention is invisible, lacks drama, often requires persistent behavior change, and may be long delayed. Avoidable harm is accepted as normal.”
ChenMed is a U.S.-based healthcare company that provides primary medical care mainly for senior citizens, especially those enrolled in Medicare. Its 21 February 2023 account headlined “How Do Social Determinants of Health Affect Care Outcomes?” provides startling statistics showing the colossal weight of the other factors of health than clinical care. “Did you know that clinical care only has about a 10% to 20% impact on a patient’s health outcomes? The remaining 80% to 90% can be attributed to social determinants of health, which are socioeconomic and environmental variables that directly affect a person’s lifestyle.
Social determinants of health (SDOH) are the conditions and circumstances in which people are born, grow, work, live, and age. Generally, SDOH can be grouped into five categories: economic stability, education access and quality, healthcare access and quality, neighborhood and build environment, social and community context.”
Chen Med further explains “Each category of SDOH has the potential to greatly impact an individual’s health. For instance, people who don’t have convenient access to large or affordable grocery stores are less likely to purchase healthy foods. They struggle to maintain adequate nutrition and, as a result, experience an increased risk of conditions like heart disease, diabetes, and obesity.
Those who experience economic instability may similarly struggle with affording the necessities they need to maintain optimal health. For example, they may hesitate to visit a primary care physician when they’re sick to avoid paying a co-pay (or paying out-of-pocket costs if they’re uninsured). Or, if a prescription medicine is too expensive, they may not have it filled. Ultimately, the more SDOH a person struggles with, the more likely they’ll experience lethal health problems, such as strokes.”
Despite the overwhelming evidence that social and environmental conditions account for the vast majority of health outcomes, public perception often fails to reflect this reality. Societies seldom acknowledge the vital role of determinants such as nutrition, education, living conditions, and social stability unless deliberate efforts are exerted to bring these influences into public consciousness.
For this reason, sustained and robust awareness campaigns are indispensable: they illuminate the otherwise invisible forces influencing health and gradually recalibrate how populations understand the roots of well-being. Without such systematic public education, medical care will continue to dominate attention simply because it constitutes the most visible response to illness, even though it represents only a fraction of what truly governs health. PMC supports it in strong terms. “Health promotion and disease prevention have huge impact on health, yet given low priority, risk being overlooked in universal health coverage efforts.
To effectively prioritize promotion and prevention, strong cadres of personnel are needed with expertise in legislation and health policy, social and behavior change communication, prevention and community health, health journalism, environmental health, and multisectoral health promotion.”
Income, social status and education
“Income and social status – higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health,” the WHO says. Chen Med states “This includes an individual’s income and employment. Those without steady jobs, for instance, are more likely to live in poverty and often can’t access the necessities they need to stay healthy.”
The WHO contends “Education – low education levels are linked with poor health, more stress and lower self-confidence.” Chen Med says “A solid education provides children with the foundation they need to earn a higher income later in life, which allows them to access high-quality healthcare. People with higher education have been shown to be healthier and live longer.”
Physical environment and social support networks
“Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions,” the WHO explains. Chen Med echoes “A person’s immediate surroundings dictate lifestyle factors such as access to healthy foods, opportunities for physical activity, safe transportation, levels of racism and discrimination, and other conditions such as water and air quality.”
The WHO says “Social support networks – greater support from families, friends and communities is linked to better health. Culture – customs and traditions, and the beliefs of the family and community all affect health.”Chen Med says “Social and community context: this reflects a person’s socioeconomic status and includes elements like social discrimination (e.g., bullying). Ultimately, those with lower socioeconomic positions have worse health and a higher rate of illness.”
“Genetics – inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health,” according to the WHO.
Health services and gender
The WHO states “Health services – access and use of services that prevent and treat disease influences health.” Meanwhile, Chen Med underlines “Healthcare access and quality: many people do not have access to healthcare because they are uninsured or lack transportation. Those who are uninsured often never establish a connection with a primary care provider and, as a result, don’t receive screenings to catch serious conditions at an early stage.”
The WHO highlights “Gender – men and women suffer from different types of diseases at different ages.”
Ultimately, rethinking health through the lens of its broader determinants compels a fundamental shift in how societies allocate attention, resources, and responsibility. Hospitals and clinical care remain essential for treating illness, yet they intervene largely at the final stage of a much longer causal chain shaped by income, education, environment, social conditions, and everyday behaviors. If these upstream factors continue to be overlooked, health systems will remain reactive rather than proactive—treating disease while leaving its roots largely intact.
The evidence therefore stands clear: upgrading health outcomes forms not only a medical task but a societal one. It demands coordinated action across sectors, sustained investment in prevention, and deliberate efforts to address inequality and structural disadvantage. Only by elevating these hidden determinants to the center of public policy and consciousness can communities shift from simply managing illness to genuinely producing health.