VCE Health & Human Development (Year 11) · Unit 1 — Understanding Health and Wellbeing · 20m read

Determinants of Health

Ever wondered why your friend can eat junk food and stay healthy while you get sick easily? The answer isn't just genetics—it's the "determinants of health," which are the conditions around you like where you live, your income, education, and access to healthcare that actually shape whether you get sick or stay well. Understanding these interconnected factors helps you see that health isn't just personal choice; it's deeply influenced by your circumstances, and this knowledge is crucial for VCE health studies and making sense of real health inequality.

Learning objective: Categorise and analyse the determinants of health and explain how they interact to influence health outcomes.

By the end of this lesson you can:

• I can distinguish biological, sociocultural, commercial and environmental determinants.
• I can explain how the social gradient in health arises from determinants.
• I can analyse a scenario using multiple determinant categories.

Determinants are the roots of health. Biological, behavioural and social roots below ground shape the health that grows above.

Categories of health determinants

Health outcomes are shaped by a range of factors called determinants of health. VCAA HHD categorises these as:

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### Biological determinants

Factors related to the body and genetics:
- Genetics/family history: inheritable predispositions (e.g., BRCA genes for breast cancer; familial hypercholesterolaemia).
- Age: risk profiles change at different life stages.
- Sex: some conditions more common in males or females (e.g., higher cardiovascular risk in males).
- Hormonal factors: affect metabolism, mood, reproductive health.
- Body weight: obesity is a biological state that increases risk of diabetes, CVD, certain cancers.

### Sociocultural determinants

The social and cultural conditions of everyday life:
- Socioeconomic status (SES): income, education, employment. Higher SES → better health outcomes (the "social gradient").
- Education level: higher education → health literacy, better decision-making, higher earning capacity.
- Social support: strong networks buffer stress and provide practical help.
- Cultural background: cultural beliefs influence diet, healthcare-seeking behaviour, treatment acceptance.
- Gender roles: affect health behaviours (e.g., masculinity norms may discourage men from seeking help).
- Discrimination and racism: persistent stress, reduced opportunities.

### Commercial determinants

Actions of commercial entities (private companies) that affect health:
- Tobacco and alcohol marketing: especially to youth.
- Food industry: ultra-processed food availability, marketing, pricing.
- Pharmaceutical companies: research priorities, drug pricing.
- Social media algorithms: promoting body image issues, misinformation.

### Environmental determinants

The physical, built and natural environments:
- Physical environment: air/water quality, climate, exposure to chemicals.
- Built environment: availability of parks and green spaces, walkability, access to healthy food.
- Climate change: heat-related illness, spread of mosquito-borne diseases, food security threats.
- Housing: overcrowding, housing quality, homelessness.

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### The social gradient in health

Health improves steadily as you move up the socioeconomic ladder — this is not a simple divide between the poor and the well-off, but a continuous gradient. The Marmot Review (UK) documented this comprehensively.

Why? Higher SES provides:
- More stable income → better nutrition, housing, healthcare access
- Higher education → better health literacy, employment in less physically risky work
- More control over one's life → less chronic stress

### Determinants interact

No determinant operates alone. SES affects access to healthy food (environmental) and education (sociocultural) and creates chronic stress (biological stress response). This is why single-factor interventions often fail.

Categorising determinants

• Biological: Genes, age, sex, hormones, existing conditions — things in the body.
• Sociocultural: SES, education, social support, culture, discrimination — social context.
• Commercial: What companies produce, market and sell — especially food, tobacco, alcohol, social media.
• Environmental: Physical surroundings: air, water, built environment, housing, climate.
• Intersect: Most health issues involve multiple categories simultaneously.

Quick reference

| Determinant type | Examples |
|---|---|
| Biological | Genetics, blood pressure, BMI |
| Behavioural | Smoking, diet, physical activity |
| Social | Income, education, housing, social isolation |
| Environmental | Air quality, access to services |

Worked example (Medium)

Explain how education level (a sociocultural determinant) can influence physical health outcomes.

1. Direct pathway — health literacy. Higher education levels are associated with greater health literacy — the capacity to find, understand and use health information. Educated individuals are more likely to understand nutrition labels, follow medication instructions correctly, and recognise warning symptoms requiring medical attention.
2. Indirect pathway — employment and income. Education leads to better employment prospects and higher income. Higher income provides access to healthier food, better housing, private health insurance, and gym memberships. It also reduces chronic financial stress, which is a biological risk factor for cardiovascular disease.
3. Behavioural pathway. Education is associated with healthier behaviours: lower smoking rates, more physical activity, moderate alcohol consumption. These behaviours directly affect physical health outcomes.

Answer: Education affects physical health through multiple pathways: directly (health literacy), indirectly (income → resources), and behaviourally (healthier choices). This illustrates how sociocultural determinants produce the social gradient in health.

Worked example (Hard)

Emma, 12, lives in public housing in a low-income area. There are no parks nearby, her school has no canteen, and her parents work multiple jobs. Analyse Emma's health determinants using all four categories.

1. Biological. At age 12, Emma is entering adolescence — hormonal changes affect mood and development. If her parents have chronic conditions (e.g., Type 2 diabetes), there may be genetic predispositions.
2. Sociocultural. Low SES: reduced access to nutritious food and healthcare. Parents working multiple jobs means less parental supervision, potential food insecurity, and limited health literacy. Social support may be strained by parents' time constraints.
3. Commercial. Low-income neighbourhoods often have higher concentrations of fast food outlets and convenience stores (food deserts), shaped by commercial decisions to locate cheap, processed food near lower-income communities.
4. Environmental. No parks nearby limits physical activity. Public housing may have air quality or mould issues. No school canteen reduces access to nutritious food during school hours.

Answer: Emma faces compounding determinants across all four categories — this is why health inequality is structural, not just individual choice.

Common mistakes

• Treating determinants as independent Students list determinants from separate categories without connecting them. VCAA expects interrelationship analysis. Fix: Show how determinants compound: "Low income (sociocultural) restricts access to fresh food (environmental), increasing reliance on fast food outlets (commercial), raising the risk of obesity (biological)."
• Blaming individuals rather than structural factors Writing "unhealthy people choose to eat junk food" ignores the determinants that constrain choices. Fix: Frame answers structurally: "Limited access to affordable fresh food and heavy marketing of processed food constrain dietary choices, particularly in low-SES areas."
• Forgetting commercial determinants Students remember biological, sociocultural and environmental but overlook commercial — the newest category in the VCAA study design. Fix: Always check: is a company or industry affecting health? Tobacco marketing, food industry, alcohol advertising, social media algorithms are all commercial determinants.

The Marmot Review — evidence for the social gradient

Sir Michael Marmot's landmark research provides the strongest evidence for the social gradient in health. Two key studies:

The Whitehall Studies (1967-present): Studied British civil servants — all had healthcare access, stable employment, and office-based work. Despite this, there was a clear gradient: the lowest-ranking employees had three times the mortality rate of the highest-ranking. This gradient persisted after controlling for known risk factors (smoking, blood pressure, cholesterol). The key variable was control — lower-ranking workers had less autonomy, less predictability, and more stress from having demands placed on them without the ability to manage those demands.

Marmot's six policy domains (2010): The Marmot Review identified six areas for reducing health inequalities in England:
1. Give every child the best start in life
2. Enable all people to maximise their capabilities and have control over their lives
3. Create fair employment and good work for all
4. Ensure a healthy standard of living for all
5. Create and develop healthy and sustainable places and communities
6. Strengthen the role and impact of ill-health prevention

Relevance to VCE HHD: Marmot's work demonstrates that health inequality is not simply about poverty — it is about the gradient of social advantage. Even middle-class people have worse health than upper-class people. This supports the VCE framework that determinants operate across the entire population, not just at the extremes.

Practice questions

1. Tobacco marketing targeting teenagers is an example of which determinant category?

   1. Biological
   2. Sociocultural
   3. Commercial
   4. Environmental

   (1 marks)

2. Explain the "social gradient in health" with reference to TWO sociocultural determinants.

   (3 marks)

Summary

• Four categories: biological (body/genes), sociocultural (SES, culture), commercial (company actions), environmental (surroundings).
• Social gradient: health improves with rising SES — continuous, not just a rich-poor divide.
• Determinants interact: compound effects explain why health inequality is structural.
• Commercial determinants often operate through environmental means (food deserts, advertising).