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Family medicine

More than health care: Social determinants of health: Thinking outside the box

Dr Wilbroad Mutale (MD ,MPhil, PhD)


What are social determinants of health important?

While health service delivery is key to improving population health, it is not sufficient. Sickness and ill health are closely related to what are known as social determinants of health. WHO defines social determinants of health as conditions in which people are born, grow, work, live, and age, including the wider economic policies and systems, development agendas, social norms, social policies and political systems. These conditions could be summarised as “social environment” and “physical environment”.


Social environment:

Social environment determinants include interactions with family, friends, co-workers, cultural attitudes, norms, and expectations. It encompasses social relationships and policies in settings such as schools, neighbourhoods, workplaces, businesses, places of worship, health care settings, recreation facilities and other public places.


Physical environment:

Physical environment consists of the natural environment (i.e., plants, atmosphere, weather, and topography) and the built environment (i.e., buildings, spaces, transportation systems, and products that are created or modified by people). Physical environments can consist of particular individual or institutional settings, such as homes, markets, schools, health care settings or recreational settings.


Why are social determinants of health important for a healthy Zambia?

 When talking about a healthy national, social determinants of health matter, as they predispose the population to ill health. So health is not achieved by simply building more hospitals or recruit more doctors. Unhealthy population has low capacity to contribute to economic develop thereby perpetuating the cycle of poverty and ill health. Closely related to this vicious cycle are the low literacy levels both in the rural and urban areas. In Zambia, many people lack basic education. This puts them at risk of disease, as low education is associated with poor health outcomes including, maternal and child outcomes leading to high mortality and morbidity.  In the current scenario of cholera outbreak, the less privileged are more likely to be exposed to cholera and subsequently have a high risk of dying due to poor health care seeking behaviours and lack of resources.

The water supply in several residential areas remain poor with no sanitation facilities. These social circumstance puts the population of at risk not disease including Cholera and other communicable diseases.


What is the way forward for Zambia?

Going forward, it is important that an integrated approach to tackling social determinants of health is well outlined. A clear plan is required to systematically improve water and sanitation, housing and education especially among women. An inter-ministerial committee on social determinants of health should be established to be coordinated by the Ministry of Health. Other line ministries like local government, Education and agriculture must be key drivers of this committee. A common framework and roadmap should be developed looking at linkages and points where each ministry can leverage to break the vicious cycle of poverty, literacy and disease. This inter-ministerial committee must have common funding portals for co-functions linked to areas of common interventions.



Unless we can tackle social determinants of health holistically, a healthy Zambia will remain an illusion. This is the right time to act. The recent adoption of Sustainable Development Goals (SDGs) by the United Nations, has provided a platform to move this agenda forward.

In Zambia, the current Cholera outbreak clear shows the importance of social determinants of health and the need to tackle these head on.

About Author

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Wilbroad Mutale
Member Since: Feb 15, 2020