Iranian Journal of Public Health 2017. 46(4):435-446.

Conceptual Models of Social Determinants of Health: A Narrative Review


Background: There are several conflicting conceptual models to explain social determinants of health (SDH) as responsible for most health inequalities. This study aimed to present these models in historical perspective and provide main component of SDH models as an SES indicators.

Methods: This was a narrative study using international databases to retrieve literature dealing with conceptual models of SDH. All publication in English language until Mar 2015 was included. The CASP and PRISMA were used to summarize the literature.

Results: Overall, 248 publications were retrieved and screened. After exclusion of irrelevant and duplicates, 94 citations were found to be relevant and 21 publications included in this review. In general, 21 models of SDH were found: some models presented before year 1995(n=4), some models presented between 1995 and 2005 (n=13) and some models presented after 2005 (n=4). However, we found three categories of indicators that contribute to SDH models and that were classic factors, fixed and demographic factors and proxy factors.

Conclusion: Reduction of socioeconomic inequalities in health requires understanding of mechanisms and causal pathways; therefore, every country needs to design the specific model. As the available models are for developed countries, lack of a specific model for developing ones is tangible. As there is no gold standard related to SES indicators, therefore, it is proposed to use the various indicators based on life course approach, which leads to understanding and adopting effective policy interventions.



Conceptual model; Social determinants of health; Health inequalities; SES indicator

Full Text:



Huynen M, Martens P, Hilderink H (2005). The health impacts of globalization: a conceptual framework. Global Health, 1(1):14.

Bayati M, Akbariyan R, Kavosi Z, Sadraei Javaheri A, Amini Rarani M, Delavari S (2012). Socioeconomic determinants of health in the countries of West Pacific: analysis of panel data. Social Welfare, 12 (47): 111-30.

Brooks E, Burns D, Gamble K et al (2002). Strategies for public health: a compendium of ideas, experience and research from Minnesota’s public health professionals. Vol. 2. Minnesota: Minnesota Department of Health.

Emamgholipour sefidashti S, Nakhaei M, Kazemi Karyani A, Ghazanfari S (2015). Decomposition socioeconomic inequality in infant mortality in EMRO countries. Int J Pediatr, 3(4-1): 749-56.

Marandi SA (2013). Social determinants of health. In: Handbook of public health. Hatami and et al. Tehran: Arjmand, Tehran, Vol. 3 pp: 2037-47.

Link BG, Phelan J (1995). Social conditions as fundamental causes of disease. J Health Soc Behav, Spec No:80-94.

Marmot M (2007). Achieving health equity: from root causes to fair outcomes. Lancet, 370(9593): 1153–63.

Wilkinson R, Marmot M (2003). Social determinants of health: the solid facts. 2nd ed. Copenhagen: WHO Regional Office for Europe. Copenhagen.

Irwin A, Valentine N, Brown C H, et al (2006). The Commission on Social Determinants of Health: tackling the social roots of health inequities. PLoS Med, 3(6): e106.

Commission on Social Determinants of Health (2007). A conceptual framework for action on the social determinants of Health. Geneva: WHO; 2007.

WHO (2015). What are social determinants of health? Geneva: WHO.

Gontijo DT (2010). Social determinants of health: perspective for understanding the relationship between processes of social exclusion and equity in health. Rev Eletr Enf, 12(1):9.

Raphael D (2008). Getting serious about the social determinants of health: new directions for public health workers. Promot Educ,15(3): 15-20.

Herd P, Goesling B, House JS (2007). Socioeconomic position and health: the differential effects of education versus income on the onset versus progression of health problems. J Health Soc Behav, 48(3): 223-38.

Adler NE, Newman K (2002). Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood), 21(2): 60-76.

Kunst AE, Bos V, Mackenbach JP (2001). Monitoring socio-economic inequalities in health in the European Union: guidelines and illustrations.

Welch VA. What is the role of systematic review in tackling health inequality?[PhD Thesis]. Facualty of Graguate and Posdoctoral Studies, University of Ottawa, Canada: 2010.

Howlader MR (2013). An analyzing the socio- demographic variables impact on health status of Bangladesh.

Khang YH, Kim HR (2005). Explaining socioeconomic inequality in mortality among South Koreans: an examination of multiple pathways in a nationally representative longitudinal study. Int J Epidemiol, 34(3): 630-7.

Pevalin DJ, Robson K (2007). Social determinants of health inequalities in Bosnia and Herzegovina. Public Health, 121(8): 588–95.

Vahdaninia MS, Ebadi M, Azin SA, et al (2011). How people rate their own health: a nationwide study from Iran. Payesh, 10 (3): 355-63.

Howlader MR (2012). An estimation of health production function of Bangladesh.

Wary LA, Alwin DF, MacCammon RJ (2005). Social status and risky health behaviors: results from the health and retirement study. J Gerontol B Psychol Sci Soc Sci, 60 Spec No 2:85-92.

Adler NE, Boyce WT, Chesney MA, Folkman S, Syme SL (1993). Socioeconomic inequalities in health: no easy solution. JAMA, 269(24): 3140–5.

WHO (2013). Handbook on health inequality monitoring: with a special focus on low- and middle-income countries. Geneva: World Health Organization.

Evans RG, Stoddart GL (2003). Consuming research, producing policy. Am J Public Health, 93(3):371–9.

Krieger N (2008). Proximal, distal and the politics of causation: what’s level got to do with it? Am J Public Health, 98(2):221–30.

Solar O, Irwin A (2007). Towards a conceptual framework for analysis and action on the social determinants of health. Geneva: WHO Commission on Social Determinants of Health.

Levine R, What Works Working Group, Kinder M (2004). Millions saved: proven successes in global health. Washington, DC: Center for Global Development.

Cockerham WC (2007). Social causes of health and disease. Cambridge: Polity.

Starfield B (2006). State of the art in research on equity and health. J Health Polit Policy Law, 31(1):11–32.

Starfield B (2007). Pathways of influence on equity in health. Soc Sci Med, 64(7):1355–62.

Baum A, Garofalo JP, Yali AM (1999). Socioeconomic status and chronic stress: does stress account for SES effects on health? Vol. 896. New York: Annals of the New York Academy of Sciences, pp. 131–44.

House JS, Williams D (2000). Understanding and reducing socioeconomic and racial/ethnic disparities in health. In: Promoting health: intervention strategies from social and behavioral research. Smedley, BD, Syme, SL, eds. Washington, DC: National Academy Press, pp. 81–124.

House JS (2002). Understanding social factors and inequalities in health: 20th Century progress and 21st Century prospects. J Health Soc Behav, 43(2):125–142.

Kaplan GA (1999). Part III summary: what is the role of the social environment in understanding inequalities in health? In: Socioeconomic status and health in industrialized nations. Adler NE, Marmot M, McEwen B, Stewart J, eds. New York: Annals of the New York Academy of Sciences, pp. 116–9.

Kuh D, Ben-Shlomo Y (1997). A life course approach to chronic disease epidemiology. Oxford, UK: Oxford University Press.

Carr-Hill R, Chalmers-Dixon P (2005). The public health observatory handbook of health inequalities measurement. Oxford: South East Public Health Observatory.

Tarrant C, Wobi F, Angell E (2013). Tackling health inequalities: socio-demographic data could play a bigger role. Fam Pract, 30(6):613-4.

Miles MB, Huberman AM (1994). Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks, CA: Sage Publications.

Krieger N (2001). A glossary for social epidemiology. J Epidemiol Community Health, 55(10): 693–700.

Brennan Ramirez LK, Baker EA, Metzler M (2008). Promoting health equity: a resource to help communities address social determinants of health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Commission on Social Determinants of Health (CSDH) (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization.

Williams DR (1990). Socioeconmic differentials in health: a review and redirection. Soc Psychol Q, 53(2): 81-99.

Diderichsen E, Whitehead M (2001). The social basis of disparities in health. In: Challenging inequities in health: from ethics to action. Evans T. et al., eds. New York: Oxford University Press.

Dahlgren G, Whitehead M (1993). Tackling inequalities in health: what can we learn from what has been tried? Working paper prepared for the King’s Fund International Seminar on Tackling Inequalities in Health, September 1993, Ditchley Park, Oxford shire. London: King’s Fund.

Mackenbach JP, van de Mheen H, Stronks K (1994). A prospective cohort study investigating the explanation of socioeconomic inequalities in health in The Netherlands. Soc Sci Med, 38(2): 299–308.

Hertzman C (1999). Population health and human development. In: Developmental health and the wealth of nations: social, biological, and educational dynamics. Keating DP, Hertzman C, eds. New York: Guildford Press. pp. 21–40.

Howden-Chapman P, Tobias M (2000). Social inequalities in health: New Zealand 1999. Wellington: Ministry of Health.

Adler NE, Ostrove JM (1999). Socioeconomic status and health: what we know and what we don’t. Ann N Y Acad Sci, 896: 3–15.

Brunner E, Marmot M (1999). Social organization, stress and health. In: Social determinants of health. Marmot M, Wilkinson R, eds. Oxford: Oxford University Press.

Claeson M, Griffin C, Johnston T et al (2002). Poverty reduction and the health sector - the health, nutrition, and population network's chapter in the World Bank's poverty reduction strategy sourcebook.

Turrell G, Mathers CD (2000). Socioeconomic status and health in Australia. Med J Aust, 172(9): 434–8.

Evans T, Brown H (2003). Road traffic crashes: operationalizing equity in the context of health sector reform. Inj Control Saf Promot, 10(1-2): 11-12.

Ansari Z, Carson NJ, Ackland MJ, Vaughan L, Serraglio A (2003). A public health model of the social determinants of health. Soz Praventivmed, 48(4): 242-51.

O’Hara P (2005). Creating social and health equity: adopting an Alberta social determinants of health framework. Discussion paper.

Graham H, Kelly MP (2004). Health inequalities: concepts, frameworks and policy. London: Health Development Agency.

Hambleton IR, Clarke K, Broome HL, et al (2005). Historical and current predictors of self-reported health status among elderly persons in Barbados. Rev Panam Salud Publica, 17(5-6):342–52.

Commission on Social Determinants of Health (2005). Towards a conceptual framework for analysis and action on the social determinants of health.

Solar O, Irwin A 92010). A conceptual framework for action on the social determinants of health. Social determinants of health discussion paper 2 (Policy and Practice). Geneva: World Health Organization.

Kelly MP, Stewart S, Morgan A, et al (2009). A conceptual framework for public health: NICE’s emerging approach. Public Health, 123(1): e14–20.

Senterfitt JW, Long A, Shih M, Teutsch SM (2013). How social and economic factora affect health.

Australian Institute of Health and Welfare (2014). Australia’s health 2014. Australia’s health series no. 14. Cat. no. AUS 178. Canberra: AIHW.

Shavers V (2007). Measurement of socioeconomic status in health disparities research. J Natl Med Assoc, 99(9):1013-23.

Grundy E, Holt G (2001). The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health, 55(12):895–904.

Freedman V, Martin L (1999). The role of education in explaining and forecasting trends in functional limitations among older Americans. Demography, 36(4):461–73.

Agheli L, Emamgholipour S (2015). Determinants of life expectancy at birth in Iran: a modified Grossman health production function. Eur Online J Nat Soc Sci, 4(2): 427-37.

Ross CE, Mirowsky J (1995). Does unemployment affect health? J Health Soc Behav, 36(3): 230-43.

Yen IH, Moss N (1999). Unbundling education: a critical discussion of what education confers and how it lowers risk for disease and death. Ann N Y Acad Sci, 896:350-1.

Lynch J, Kaplan G (2000). Socioeconomic position. In: Social Epidemiology, Berkman LF, Kawachi I, ed. 1st ed. Oxford: Oxford University Press, pp. 13–35.

Davey Smith G, Hart C, Hole D, et al (1998). Education and occupational social class: which is the more important indicator of mortality risk? J Epidemiol Community Health, 52(3), 153–60.

Mackenbach JP, Kunst AE, Cavelaars AEJM, Groenhof F, Geurts JJM (1997). The working group on socioeconomic inequalities in health socioeconomic inequalities in morbidity and mortality in Western Europe. Lancet, 349(9066):1655-9.

Tsimbos C (2010). An assessment of socio-economic inequalities in health among elderly in Greece, Italy and Spain. Int J Public Health, 55(1):5–15.

National Advisory Committee on Health and Disability (1998). The social, cultural and economic determinants of health in New Zealand: action to improve health.

Fuchs VR (2004). Reflections on the socio-economic correlates of health. J Health Econ, 23(4): 653–61.

Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P (2012). WHO European review of social determinants of health and the health divide. Lancet, 380(9846): 1011-29.

Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Pérez-Stable EJ (1987). Development of a short acculturation scale for Hispanics. Hisp J Behav Sci, 9(2): 183-205.

Kawachi I, Subramanian SV, Almeida-Filho N (2002). A glossary for health inequalities. J Epidemiol Community Health, 56(9):647–52.

Klugman J (2002). A Sourcebook for Poverty Reduction Strategies, vol. 2.

Graham H (2009). Understanding health inequali-ties.2nd ed. Berkshire: Open University Press.

Robert S, House JS (1996). SES differentials in health by age and alternative indicators of SES. J Aging Health, 8(3):359–88.

Huisman M, Kunst AE, Andersen O, et al (2004). Socioeconomic inequalities in mortality among elderly people in 11 European populations. J Epidemiol Community Health, 58(6):468–75.

Duncan GJ, Daly MC, McDonough P, Williams DR (2002). Optimal indicators of socioeconomic status for health research. Am J Public Health, 92(7):1151–7.

Galobardes B, Lynch J, Davey Smith G (2007). Measuring socioeconomic position in health research. Br Med Bull, 81-82: 21–37.

Watt R (2002). Emerging theories into the social determinants of health: implications for oral health promotion. Community Dent Oral Epidemiol, 30(4):241–7.

Galobardes B, Shaw M, Lawlor DA, (2006). Indicators of socioeconomic position (part 1). J Epidemiol Community Health, 60(1):7–12.

Helman CG (2007). Culture, health and illness. 5th ed. London: Hodder Arnold Publication.

O’Mara-Eves A, Brunton G, McDaid D, et al (2013). Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Res, 1(4):i-525.

Trust for America’s Health (2015). The facts hurt: a state-by-state injury prevention policy report.

Chittleborough CR, Baum FE, Taylor AW, Hiller JE (2006). A lifecourse approach to measuring socioeconomic position in population health surveillance systems. J Epidemiol Community Health, 60(11): 981–92.

Babones SJ (2009). Social inequality and public health. Bristol:

Mackenbach JP, Bakker MJ, Kunst AE, Diderichsen F (2002). Socioeconomic inequalities in health in Europe: an overview. In: Reducing inequalities in health: a European perspective. Mackenbach J, Bakker M, eds. London: Routledge, pp.3-19.

van de Mheen D (1998). Inequalities in heath, to be continued? a life-course perspective on socio-economic inequalities in health. Amsterdam: Ponsen & Looijen BY, Wageningen.

OECD and WHO (2003). Poverty and health (DAC guidelines and reference series). Paris: OECD Publication Services.

Benoit C, Shumka L (2009). Gendering the health determinants framework: why girls and women’s health matters. Vancouver: Women’s Health Research network.

Bradshaw D (2008). Determinants of health and their trends. In: South African health review. Barron P, Roma-Reardon J, eds. Durban: Health Systems Trust.

Whitehead M, Dahlgren G, Gilson L (2001). Developing the policy response to inequities in health: a global perspective. In: Challenging inequities in health care: from ethics to action. Evans T, Whitehead M, Diderichsen F, Bhuia A, Wirth M eds. New York: Oxford University Press,pp. 309-22.

Hayden TC. Socioeconomic determinants as predictors of disparities in health outcomes in Kentucky [PhD thesis]. Kent School of Social Work, University of Louisville, United States: 2010.

Exworthy M (2008). Policy to tackle the social determinants of health: using conceptual models to understand the policy process. Health Policy Plan, 23(5): 318–27.

Mikkonen J, Raphael D (2010). Social determinants of health: the Canadian facts. Toronto: York University School of Health Policy and Management.

Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M (2010). Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health, 64: 284-291.

Signal L, Martin J, Cram F, Robson B (2008). The health equity assessment tool: a user’s guide. Wellington: Ministry of Health.

Graham H (2008). Unequal lives: health and socioeconomic inequalities. Int J Epidemiol, 37 (5): 1195-1196.

National Health Committee (1998). The social, cultural and economic determinants of health in New Zealand: action to improve health. Wellington: National Advisory Committee on Health and Disability.

Diez Roux AV (2012). Conceptual Approaches to the Study of Health Disparities. Annu Rev Public Health, 33: 41–58.

Asemane Z, Emamgholipour S, Rshidian A (2015). Governance and Public Health Outcome in OPEC countries. Int J Rev Life Sci, 5(10): 855-60.

Zaboli R, Malmoon Z, Seyedjavadi M, Seyedin H (2014). Developing a conceptual model of social determinants of health inequalities: A qualitative study. JHPM, 3(4): 74-88.

Oakes JM, Kaufman JS (2006). Methods in social epidemiology. 1st ed. San Francisco: Jossey-Bass.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.