Wider Determinants of Health

  • Sabine Bährer-KohlerEmail author
  • Brendan McLoughlin


Wider determinants of health are most complex, and there exists a complex interaction between lifestyle and the physical, social, and economic environment and individual characteristics. Wider determinants of health play an important role in the mental health of older adults. During primary care assessment of patients’ mental wellbeing, it is important to consider the broader influences on the individual, such as physical health, family/friends and social networks, finances/debts, alcohol and drug use, life events, etc. These wider determinants should be taken into consideration when giving health promotion information. As the wider determinants are often outside the scope of primary care, GPs and others should work with other professionals such as social workers in order to ensure holistic assessment of the older adult’s needs and appropriate care planning. Professionals should be mindful of cultural influences, diversities, and differences, maintaining the individual’s dignity during the process.


Social determinants Life course Social networks Social support Social participation Diagnostic aspects Assessment tools Primary care assessment Health promotion Comprehensive primary health care 


  1. 1.
    UN. Ageing. 2015. Accessed 14 Sept 2015/26 Jan 2016.
  2. 2.
  3. 3.
    Qiu C, Kivipelto M, von Strauss E. Epidemiology of Alzheimer’s disease: occurrence, determinants, and strategies toward intervention. Dialogues Clin Neurosci. 2009;11(2):111–28.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Tsouros AD/WHO, editor. Social determinants of health- the solid facts. Geneva: World Health Organization; 2003.Google Scholar
  5. 5.
    WHO. Social determinants of health- the solid facts. Geneva: World Health Organization; 2003.Google Scholar
  6. 6.
    Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm: Institute for Futures Studies; 1991.Google Scholar
  7. 7.
    Mitchell SM, Shortell SM. The governance and management of effective community health partnerships: a typology for research, policy, and practice. Milbank Q. 2000;78(2):241–89. 151.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    American Society of Ageing, Wallace SP. Equity and social determinants of health among older adults. American Society of Ageing, Generations. Accessed 21 Sept 2015/26 Jan 2016.
  9. 9.
    Parker L, Moran GM, Roberts LM, Calvert M, McCahon D. The burden of common chronic disease on health related quality of life in an elderly community-dwelling population in the UK. Fam Pract. 2014;31(5):557–63. Scholar
  10. 10.
    Stone JR. Elderly and older racial/ethnic minority healthcare inequalities—care, solidarity, and action. Camb Q Healthc Ethics. 2012;21(3):342–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Rainer S. Social participation and social engagement of elderly people. Procedia Soc Behav Sci. 2014;116(21):780–5.CrossRefGoogle Scholar
  12. 12.
    Silva Vde L, Cesse EÂP, de Albuquerque Mde F. Social determinants of death among the elderly: a systematic literature review. Rev Bras Epidemiol. 2014;17(Suppl 2):178–93.CrossRefGoogle Scholar
  13. 13.
    World Health Organization. What is mental health? Geneva: World Health Organization; 2013.
  14. 14.
    Lee, M. Promoting mental health and well-being in later life: a first report from the UK inquiry into mental health and well-being in later life. London: Age Concern and the Mental Health Foundation; 2006.
  15. 15.
    Keyes CLM. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73(3):539–48.PubMedCrossRefGoogle Scholar
  16. 16.
    Whitehead M, Dahlgren G. What can be done about inequalities in health? Lancet. 1991;338(8774):1059–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Solar O, Irwin A. 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; 2010.Google Scholar
  18. 18.
    Wanless D, Mitchell BA, Wister AV. Social determinants of health for older women in Canada: does rural–urban residency matter? Can J Aging. 2010;29(2):233–47.PubMedCrossRefGoogle Scholar
  19. 19.
    Hoi V, et al. Health-related quality of life, and its determinants, among older adults in rural Vietnam. BMC Public Health. 2010;10:549. Scholar
  20. 20.
    Bos AM, Bos AJ. The socio-economic determinants of older adults’s health in Brazil: the importance of marital status and income. Ageing Soc. 2007;27:385–405.CrossRefGoogle Scholar
  21. 21.
    Health Scotland. Mental health and wellbeing in later life; older adults’ perceptions. Edinburgh: Health Scotland; 2004. Scholar
  22. 22.
    Surkan PJ, et al. Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis. Bull World Health Organ. 2011;89(8):608–15.PubMedCrossRefGoogle Scholar
  23. 23.
    Eastwood JG, et al. Relationship of postnatal depressive symptoms to infant temperament, maternal expectations social support and other potential risk factors: findings from a large Australian cross-sectional study. BMC Pregnancy Childbirth. 2012;12:148.
  24. 24.
    Water Aid. The sanitation problem: what can and should the health sector do? London: Water Aid; 2011.Google Scholar
  25. 25.
    Ford E, Clark C. The influence of childhood adversity on social relations and mental health at mid-life. J Affect Disord. 2011;133(1–2):320–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Hanson M, Chen E. Socioeconomic status and health behaviors in adolescence: a review of the literature. J Behav Med. 2007;30(3):263–85.PubMedCrossRefGoogle Scholar
  27. 27.
    Lacey R, Kumari M, Bartley M. Social isolation in childhood and adult inflammation: evidence from the National Development Study. Psychoneuroendocrinology. 2014;50:85–94. Scholar
  28. 28.
    Takizawa R, Maughan B, Arseneault L. Adult health outcomes of childhood bullying victimization: evidence from a five-decade longitudinal British birth cohort. Am J Psychiatry. 2014;171(7):777–84.PubMedCrossRefGoogle Scholar
  29. 29.
    Stein C, Moritz I. A life course perspective of maintaining independence in older age. Geneva: World Health Organization; 1999.Google Scholar
  30. 30.
    The Marmot Review Team. Fair society, healthy lives: strategic review of health inequalities in England post-2010. London: Marmot Review Team; 2010.Google Scholar
  31. 31.
    Marcus G, Neumark T, Broome S. Power lines. London: RSA; 2011.Google Scholar
  32. 32.
    Royal College of Psychiatrists. Mental health and work. London: Royal College of Psychiatrists; 2008.Google Scholar
  33. 33.
    Burcusa SL, Iacono WG. Risk for recurrence in depression. Clin Psychol Rev. 2007;27(8):959–85.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Roh S, et al. Perceived neighborhood environment affecting physical and mental health: a study with Korean American older adults in New York city. J Immigr Minor Health. 2011;13(6):1005–12.PubMedCrossRefGoogle Scholar
  35. 35.
    United Nations. The universal declaration of human rights. 1948.
  36. 36.
    Walters K, Iliffe S, Orrell M. An exploration of help-seeking behaviour in older adults with unmet needs. Fam Pract. 2001;18(3):277–82.PubMedCrossRefGoogle Scholar
  37. 37.
    APA (American Psychological Association). The American Psychological Association. Accessed 18 Sept 2015.
  38. 38.
    Lubben J. Assessing social networks among elderly populations. Fam Community Health. 1988;11(3):42–52.CrossRefGoogle Scholar
  39. 39.
    Lubben J, Gironda M. Centrality of social ties to the health and well-being of older adults. In: Berkman B, Harootyan L, editors. Social work and health care in an aging society. New York: Springer; 2003.Google Scholar
  40. 40.
    Lubben J, Gironda M. Measuring social networks and assessing their benefits. In: Phillipson C, Allan G, Morgan D, editors. Social networks and social exclusion: sociological and policy perspectives. Hampshire: Ashgate Publishing; 2004. p. 20–35.Google Scholar
  41. 41.
    Welin L, Larsson B, Svardsudd K, Tibblin B, Tibblin G. Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12-year follow up of the study of men born in 1913 and 1923. J Epidemiol Community Health. 1992;46(2):127–32.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM. Social ties and susceptibility to the common cold. JAMA. 1997;277(24):1940–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Cohen S, Hoberman H. Positive events and social supports as buffers of life change stress. J Appl Soc Psychol. 1983;13:99–125, 277: 1940–4.CrossRefGoogle Scholar
  44. 44.
    Dunkel-Schetter C, Bennett TL. Differentiating the cognitive and behavioral aspects of social support. In: Sarason BR BR, Sarason IG, Pierce GR, editors. Social support: an interactional view. New York: Wiley; 1990. p. 267–96.Google Scholar
  45. 45.
    Dunkel-Schetter C, Folkman S, Lazarus RS. Correlates of social support receipt. J Pers Soc Psychol. 1987;53(1):71–80.PubMedCrossRefGoogle Scholar
  46. 46.
    Dunkel-Schetter C, Feinstein L, Call J. UCLA Social Support Inventory (UCLA-SSI/1986). 1986.…/. Accessed 17 Sept 2015.
  47. 47.
    Barrera M. A method for the assessment of social support networks in community survey research. Connect. 1980;3:8–13.Google Scholar
  48. 48.
    WHO. The World Health Organization Quality of Life (WHOQOL). Accessed 18 Sept 2015.
  49. 49.
    WHO. WHOQOL Spirituality, Religiousness and Personal Beliefs (SRPB), WHOQOL-SRPB. 2002. Accessed 21 Sept 2015.
  50. 50.
    The WHOQOL. Group. The World Health Organization Quality of Life Assessment (WHOQOL). Development and psychometric properties. Soc Sci Med. 1998;46:1569–85.CrossRefGoogle Scholar
  51. 51.
    Selai CE, Trimble MR, Rossor MN, Harvey RJ. Assessing quality of life in dementia: preliminary psychometric testing of the quality of life assessment schedule (QOLAS). Neuropsychol Rehabil. 2001;11:3–4. 219–43CrossRefGoogle Scholar
  52. 52.
    Ready RE, Ott BR, Grace J, Fernandez I. The Cornell-Brown Scale for quality of life in dementia. Alzheimer Dis Assoc Disord. 2002;16:109–15.PubMedCrossRefGoogle Scholar
  53. 53.
    Finkel SI, Lyons JS, Anderson RL. Reliability and validity of the Cohen-Mansfield Agitation Inventory in institutionalized elderly. Int J Geriatr Psychiatry. 1992;7:487–90.CrossRefGoogle Scholar
  54. 54.
    Cohen-Mansfield J. Agitation in older adults. In: Billig N, Rabins P, editors. Abstracts in social gerontology. vol. 33, no 1. 1990. p. 114.Google Scholar
  55. 55.
    Cohen-Mansfield J, Billig N. Agitated behaviors in older adults I. a conceptual review. J Am Geriatr Soc. 1986;34:711–21.PubMedCrossRefGoogle Scholar
  56. 56.
    Prigerson HG, Maciejewski PK, Reynolds CF III, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M. The inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995;59(1–2):65–79.PubMedCrossRefGoogle Scholar
  57. 57.
    Gross C, Seebass K. The Standard Stress Scale (SSS): measuring stress in the life course. NEPS Working Paper No. 45. 2014.Google Scholar
  58. 58.
    Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11:213–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Kawachi I, Kennedy BP, Glass R. Social capital and self-rated health: a contextual analysis. Am J Public Health. 1999;89(8):1187–93.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    GSS. General social survey. 2015. Accessed 21 Sept 2015/26 Jan 2016.
  61. 61.
    Palinkas LA, et al. Unmet needs for services for older adults with mental illness: comparison of views of different stakeholder groups. Am J Geriatr Psychiatry. 2007;15(6):530–40.PubMedCrossRefGoogle Scholar
  62. 62.
    Conner K, et al. Mental health treatment seeking among older adults with depression: the impact of stigma and race. Am J Geriatr Psychiatry. 2010;18(6):531–43.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Akincigil A, et al. Racial and ethnic disparities in depression care in community-dwelling elderly in the United States. Am J Public Health. 2012;102(2):319–28.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Frost H, Haw S, Frank J. Promoting health and wellbeing in later life. Interventions in primary care and community settings. Scottish Collaboration for Public Health Research and Policy. 2010.
  65. 65.
    Hunter CL, et al. Integrated behavioral health in primary care: step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association; 2009.CrossRefGoogle Scholar
  66. 66.
    World Health Organisation. Integrating mental health into primary care: a global perspective. Annex One: Improving the practice of primary care for mental health. Geneva: World Health Organisation and WONCA; 2008.Google Scholar
  67. 67.
    Kroenke K, et al. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613–21.PubMedGoogle Scholar
  68. 68.
    US National Library of Medicine. Benefits and risks of screening tests. 2013.
  69. 69.
    Action on elder abuse. What is elder Abuse? 2015.
  70. 70.
    Cook-Daniels, L., 2003 is the year elder abuse hits the international state. Victimiz Old Adults Disabled. 2003;5:65–6, 76.Google Scholar
  71. 71.
    World Health Organization. The Ottawa charter for health promotion: 1st international conference on health promotion. Ottawa; 1986. Accessed 31 Jan 2016.
  72. 72.
    Bhuyan KK. Health promotion through self-care and community participation: elements of a proposed programme in the developing countries. BMC Public Health. 2004;4:11.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Moreno-Peral P, Conejo-Cerón S, Fernández A, Berenguera A, Martínez-Andrés M, Pons-Vigués M, Motrico E, Rodríguez-Martín B, Bellón JA, Rubio-Valera M. Primary care patients’ perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis. PLoS One. 2015;10(5):e0125004. Scholar
  74. 74.
    Graham H. Unequal lives: health and socioeconomic inequalities. Maidenhead: Open University Press; 2007.Google Scholar
  75. 75.
    Acheson D. Independent inquiry into inequalities in health (the Acheson Report). London: HMSO Her Majesty’s Stationery Office; 1998.Google Scholar
  76. 76.
    Chang PJ, Wray L, Lin Y. Social relationships, leisure activity, and health in older adults. Health Psychol. 2014;33(6):516–23.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Fairhurst K, Huby G. From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia. Br Med J. 1998;317:1130–4.CrossRefGoogle Scholar
  78. 78.
    Lambe B, Collins C. A qualitative study of lifestyle counselling in general practice in Ireland. Fam Pract. 2010;27:219–23.PubMedCrossRefGoogle Scholar
  79. 79.
    Rubio-Valera M, Pons-Vigués M, Martínez-Andrés M, Moreno-Peral P, Berenguera A, Fernández A. Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography. PLoS One. 2014;9(2):e89554.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Kelly MP, Bonnefoy J, Morgan A, Florenzano F. The development of the evidence base about the social determinants of health. 2006. p. 17. Accessed 23 Sept 2015.
  81. 81.
    Kemppainen V, Tossavainen K, Turunen H. Nurses’ roles in health promotion practice: an integrative review. Health Promot Int. 2013;28(4):490–501.PubMedCrossRefGoogle Scholar
  82. 82.
    Carey M, Noble N, Mansfield E, Waller A, Henskens F, Sanson-Fisher R. The role of eHealth in optimizing preventive care in the primary care setting. J Med Int Res. 2015;17(5):126.Google Scholar
  83. 83.
    National Institute for Health and Care Excellence. Behaviour change, general approaches. Guideline. Public Health Guideline 6. 2007.
  84. 84.
    Repper J, et al. Peer support workers; theory and practice. London: Centre for Mental Health; 2013.Google Scholar
  85. 85.
    Chapin R, et al. Reclaiming joy: pilot evaluation of a mental health peer support program for older adults who receive Medicaid. The Gerontologist. 2013;53(2):345–52.PubMedCrossRefGoogle Scholar
  86. 86.
    Karp J, et al. Advances in understanding the mechanisms and management of persistent pain in older adults. Br J Anaesth. 2008;101(1):111–20.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Varma S, Sareen H, Trivedi JK. The geriatric population and psychiatric medication. Mens Sana Monogr. 2010;8(1):30–51.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Lindsey P. Psychotropic medication use among older adults: what all nurses need to know. J Gerontol Nurs. 2009;35(9):28–38.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Improving access to psychological therapies.
  90. 90.
    Health and Social Care Information Centre. Psychological therapies: annual report on the use of IAPT services England, 2014/15. Health and Social Care Information Centre; 2015.Google Scholar
  91. 91.
    World Health Organisation Regional Office for Europe. User empowerment in mental health—a statement by the WHO Regional Office for Europe. Copenhagen: World Health Organisation Regional Office for Europe & European Commission; 2010.
  92. 92.
    American Heritage Dictionary of the English Language. 2015. Accessed 21 Sept 2015.
  93. 93.
    Wong ST, Haggerty J. Measuring patient experiences in primary health care. 2013. Accessed 17 Sept 2015/26 Jan 2016.
  94. 94.
    Doll L, Bartenfeld T, Binder S. Evaluation of interventions designed to prevent and control injuries. Epidemiol Rev. 2003;25(1):51–9. Scholar
  95. 95.
    Burge SK, Amodei N, Elkin B, Catala S, Andrew SR, Lane PA, Seale JP. An evaluation of two primary care interventions for alcohol abuse among Mexican-American patients. Addiction. 1997;92(12):1705–16.PubMedCrossRefGoogle Scholar
  96. 96.
    Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010;64:284–91. Scholar
  97. 97.
    MacLean L, Hassmiller S, Shaffer F, Rohrbaugh K, Tiffany Collier T, Fairman J. Scale, causes, and implications of the primary care nursing shortage. Annu Rev Public Health. 2014;35:443–57.PubMedCrossRefGoogle Scholar
  98. 98.
    Kelly MP, Bonnefoy J, Morgan A, Florenzano F. The development of the evidence base about the social determinants of health. 2006. p. 19. Accessed 23 Sept 2015.
  99. 99.
    Murray CJL, Frenk J. A WHO framework for health system performance assessment. Evidence and Information for Policy. 1990. Geneva: World Health Organization, Technical Documents. Accessed 23 Sept 2015/26 Jan 2016.
  100. 100.
    Berglund E, Lytsy P, Westerling R. The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study. BMC Public Health. 2014;14:492. Scholar
  101. 101.
    WHO. Primary care evaluation tool (PCET). Accessed 18 Sept 2015/26 Jan 2016.
  102. 102.
    Lawless A, Freeman T, Bentley M, Baum F, Jolley G. Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities. BMC Fam Pract. 2014;15:99. Scholar
  103. 103.
    Levy D, Chaloupka F, Gitchell J. The effect of tobacco control policies on smoking rates; a tobacco control scorecard. J Public Health Manag Pract. 2004;10(4):338–53.PubMedCrossRefGoogle Scholar
  104. 104.
    Jallinoja P, Absetz P, Kuronen R, Nissinen A, Talja M, Uutela A, Patja K. The dilemma of patient responsibility for lifestyle change: perceptions among primary care physicians and nurses. Scand J Prim Health Care. 2007;25(4):244–9.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Kennedy JF. Special message to the Congress on protecting the consumer interest. Public Papers of the Presidents of the United States March 15, 1962, vol. 93. Washington, DC: US Government Printing Office; 1962, p. 236.Google Scholar
  106. 106.
    World Health. World alliance for patient safety. Global patient safety challenge 2005–2006: Clean Care is Safer Care. Geneva: World Health Organisation; 2005. p. 1–25. Accessed 23 Sept 2015.
  107. 107.
    Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010;85(1):53–62.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.International University of Catalonia (UIC)BarcelonaSpain
  2. 2.Dr. Bährer-Kohler & PartnersBaselSwitzerland
  3. 3.Clinical Senior Cognitive Behavioural TherapistEfficacyLondonUK

Personalised recommendations