PHIRN: Population Health Improvement Research Network

Figure 9a-b. Distribution of SDOH Studied in Academic/Grey Literature Ω

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Figures 9a and 9b outline the relative appearance of various social determinants of health (SDOH) in the literature coded for this review. A broad range of determinants were addressed. First, in the academic literature, ‘income’ was the main determinant of health of focus nearly half of the time (49.7%).  Immigrant status (36.4%) and SES (26%) were the second and third most frequently studied determinants of health. Other common determinants studied were education and literacy (24.9%), gender (24.9%), age (24.3%), Aboriginal origin (19.7%), and housing (19.1%).

Due to the ‘problematic’ use of culture in several articles, this category was separated from immigrant status, Aboriginal origin, language knowledge, and ethnicity as an additional unique social determinant of health. The term ‘culture’ per se is only applied to articles in which ‘culture’ is explicitly described as a population characteristic. Culture (19.1%), service utilization (19.1%), language knowledge (17.9%), Physical environment and neighbourhood (17.3%), access to health service utilization (12.1%), race and visible minority status (12.7%), employment (11%), and ability (18, 10.4 %) appeared as social determinants of health in relatively lesser share of articles (19%-11%) articles.

Figure 9b below presents the social determinants of health (SDOH) studied in the grey literature. In contrast to the academic literature, ‘access to health care/health service’ was the most common determinant of health studied (81.6%).1 This is followed by service utilization (60.5%), and income (54.4%). Other common determinants are health service utilization (53.5%), gender (43.0%), housing (40.4%), education (34.4%), SES (39.5%) each, immigrant status (35.1%), employment (37.7%), stigma, self-esteem, identity and self (35.1%). The grey literature also reveals a stronger emphasis on food insecurity than does the academic literature.  Although less of a striking difference, the issue of employment and unemployment is more prevalent in the grey literature.  This may reflect a time trend where the content of these reports has not yet made its way into academic articles, or possibly is due to differential research foci of organizations.

Since population health outcomes are not exclusively influenced by a single determinant, but rather result from various determinants affecting and interacting with each other at various levels, the influence of multiple determinants is very important. Common across both literatures, many articles examined overlapping social determinants of health (Forschuk et al., 2007; Jacklin, 2009; Sakamoto, 2007; Basok, 2006). For example, people of Aboriginal origin with low income demonstrate lower access to health services; or elderly women of immigrant status face language barriers to access health services. This implies that factors, such as income, health service access, immigrant/refugee status – may have an increased influence on health.

Figure 9a. Distribution of SDOH Studied in Academic Literature Ω



Figure 9b. Distribution of SDOH Studied in Grey Literature Ω


The category of ‘access to health care services’ includes the health care provided by health practitioners and other care givers that is personal in nature. The category of access to health services’ is much broader and includes all health services dealing with the diagnosis and treatment of diseases or maintenance of health, which could be personal and non-personal in nature.
Last Updated ( Tuesday, 27 September 2011 13:34 )