Position StatementHealth Promotion & The Social Determinants of Health
Social determinants of health shape one’s long-term physical, mental, emotional, and social health and well-being.
the Healthy Teen Network Board of Directors on
June 9, 2017
Healthy Teen Network believes that health promotion, or a holistic approach we call Youth 360⁰, is the best way to achieve positive health and well-being outcomes for all youth.1 How and where youth live, learn, and play matters. Health promotion is an approach that enables people to increase control over and improve their health, while also moving beyond a focus on individual behavior to a wide range of social and environmental interventions.2 We subscribe to the social-ecological model; this model is a theory-based framework that demonstrates that behavior is the result of knowledge, values, and attitudes, as well as social influences, including the family, peers, and other people with whom we associate and the schools, communities, and larger society in which we belong.3 We maintain that a health promotion approach will best foster the positive development of all young people and ensure that they are supported and empowered to lead healthy and fulfilling lives.
One cannot expect to significantly impact health outcomes without considering the full range of factors that make a critical difference. These factors, called social determinants of health, shape one’s long-term physical, mental, emotional, and social health and well-being.4
Examples of social determinants of health include
- access to quality education and health services,
- socioeconomic status, and
- having life goals and aspirations.
Significant health inequities and disparities among racial and ethnic groups persist. Adolescents and young adults who are African American, American Indian, or Latinx—especially those living in poverty—experience greater health disparities compared to their White peers5 Social determinants of health are mostly responsible for these health disparities.6 Most often, the leading causes of illness and death for young people are preventable: young people’s health outcomes, grounded in their individual behaviors, are also affected by their environments (i.e., how and where they live, learn, and play).7
Most often, the leading causes of illness and death for young people are preventable: young people’s health outcomes, grounded in their individual behaviors, are also affected by their environments (i.e., how and where they live, learn, and play).
Adolescence is an important time of developmental transition, when adolescents and young adults may be more sensitive to the environmental influences around them, in their relationships, communities, and society.8 A health promotion approach that incorporates the social-ecological model, or Youth 360°, considers the social determinants of health and moves beyond merely risk reduction or disease prevention to holistic wellness.
Access to health knowledge and services are critical to achieve health outcomes …however, they are not sufficient to achieve better outcomes for all young people. Every one of us is affected by social determinants of health at an individual level, but also through our relationships, in our communities, and in society as a whole. Beyond knowledge, we must consider, for example, the power of caregiver-child communication, or access to safe housing, or institutionalized racism if we want to increase our impact, particularly in the face of increasing health disparities. For example, positive caregiver-child communication and connectedness can protect adolescents and young adults from engaging in risk-taking behaviors.9 Academic success and achievement are strong predictors of overall health outcomes, and young people with proficient academic skills experience higher rates of healthy behaviors.10 And, adolescents and young adults who live in neighborhoods characterized by concentrated poverty are at higher risk for sexual risk-taking behaviors, lower academic achievement, and poor physical and mental health.11 These examples—all social determinants of health—highlight opportunities where we can come together to support and empower adolescents and young adults to lead healthy and fulfilling lives.
2 World Health Organization. (2017). Health promotion. Available from http://www.who.int/topics/health_promotion/en/
3 Bronfenbrenner, U. (1994). Ecological models of human development. Readings on the Development of Children, 2(1), 37-43.
4 World Health Organization, Commission on Social Determinants of Health. (2013). Closing the gap in a generation: Health equity through action on the social determinants of health. Available from http://www.who.int/social_determinants/en
5 Mulye TP, Park MJ, Nelson CD, et al. Trends in adolescent and young adult health in the United States. Journal of Adolescent Health. 2009;45(1):8-24. Available from: http://download.journals.elsevierhealth.com/pdfs/journals/1054-139X/PIIS1054139X09001244.pdf
6 World Health Organization. (2015). Social determinants of health: Key concepts. Available from: http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/
7 Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA. 1997;278(10):823-32. Available from: http://jama.ama-assn.org/cgi/reprint/278/10/823
8 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Healthy youth! Student health and academic achievement. Atlanta: CDC; 2010. Available from: http://www.cdc.gov/HealthyYouth/health_and_academics/index.htm#2
9 Leventhal T, Brooks-Gunn J. Diversity in developmental trajectories across adolescence: Neighborhood influences. Chapter 15 in Handbook of Adolescent Psychology (pp 451-86), 2nd ed. Lerner RM, Steinberg L, editors. Hoboken, NJ: John Wiley & Sons, Inc.; 2004.