Social and physical determinants of health

The World Health Organization defines the social and physical determinants of health as the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life (WHO, 2024). These include income and wealth, employment and working conditions, education and early childhood development, housing and the built environment, food security, access to healthcare, and social support networks. The WHO Commission on Social Determinants of Health, established in 2005 and producing its landmark report Closing the Gap in a Generation in 2008, established that health inequities are the result of political and economic choices about how resources and power are distributed; they are produced by those choices and can be changed by them (WHO Commission, 2008).

Solar and Irwin’s (2010) conceptual framework, developed for the WHO Commission, identifies how structural conditions translate into health outcomes through four categories of intermediary social determinants. The first is material circumstances: housing and neighbourhood quality, the financial means to access healthy food and heating, and the physical work environment. The second is psychosocial circumstances: workplace stress, job insecurity, social isolation and the presence or absence of support networks. The third is behavioural and biological factors: patterns of nutrition, physical activity, tobacco and alcohol use; all distributed differently across social groups, meaning individual behaviour is shaped by the conditions people live and work in. The fourth, and most significant for organisations, is the health system itself as a social determinant: access to occupational health, mental health services and preventative care is shaped by social position, and organisations play a direct role in widening or narrowing that gap (Solar and Irwin, 2010).

The physical determinants of health refer to the built and natural environments people inhabit: housing quality, neighbourhood safety, access to green space, exposure to air and noise pollution, workplace design, and proximity to healthcare, healthy food and transport. Research consistently shows these conditions have measurable effects on physical and mental health. Poor quality housing is associated with respiratory disease, mental health problems and increased injury risk. Workplaces with inadequate ventilation, lighting or ergonomic design are associated with chronic illness and reduced productivity. Neighbourhoods with high pollution, limited green space and poor transport are associated with higher rates of cardiovascular disease, obesity and mental ill-health (Solar and Irwin, 2010).

The relationship between social and physical determinants and health inequity is direct and well-evidenced. People on lower incomes are more likely to live in areas with higher pollution, less green space, poorer housing and fewer health services. People in precarious or low-paid employment are more likely to face unsafe working conditions, job insecurity, inadequate sick pay and limited access to occupational health. These structural disadvantages compound over time; poor health reduces the ability to work, which reduces income, which worsens living conditions and health further. The WHO describes this as a social gradient of health: the lower a person’s socioeconomic position, the worse their health outcomes are likely to be (WHO, 2024).

For CR&S practitioners, the significance of social and physical determinants lies in the direct influence that organisational decisions have on them. Employers shape the social determinants of health for their workforce through pay decisions, job security, working hours, access to sick pay, flexible working arrangements, occupational health provision, and workplace culture. A living wage, genuine flexible working and access to mental health support are interventions in the social determinants of health that reduce inequality and improve outcomes for employees and their families. Procurement decisions shape the social determinants of health for workers throughout the supply chain; a buyer that drives down supplier prices creates pressure on wages and working conditions that directly affects the health of people in sourcing regions.

Physical determinants fall within an organisation’s sphere of influence through the workplaces it controls and the communities its operations affect. Employers shape the physical environment in which employees spend a significant proportion of their waking hours through workplace design, air quality, lighting, noise levels, access to outdoor space and ergonomics. Organisations with significant physical assets affect surrounding communities through emissions, noise, traffic and land use. Addressing social and physical determinants is increasingly reflected in ESG frameworks such as GRI and CSRD, which require organisations to disclose their impacts on people including working conditions, community health and supply chain labour standards, making this a core CR&S capability.