Social determinants of health

The findings from the AIHW’s previous report Chronic health conditions among culturally and linguistically diverse Australians, 2021 raised further questions about which specific influences drive the results. Previous research indicates the patterns observed are likely to reflect the diverse cultures, languages, migration trajectories, social and economic circumstances among CALD people in Australia (AIHW 2022b; AIHW 2023; Castañeda et al. 2015; Jatrana et al. 2017; Kennedy et al. 2006; Kennedy et al. 2014; Khatri and Assefa 2022). Within countries, health and illness generally follow a social gradient: the lower the socioeconomic position the poorer the health. Social determinants of health are more important than health care or lifestyle choices, accounting for between 30–55% of health outcomes (WHO 2022).

Key social determinants of health include: 

  • income and social protection
  • education
  • unemployment and job insecurity
  • working life conditions
  • food insecurity
  • housing, basic amenities and the environment
  • early childhood development
  • social inclusion and non-discrimination
  • structural conflict
  • access to affordable health services of decent quality (WHO 2022).

Barriers to accessing health services and information include poor health literacy, lack of translated materials, limited use of interpreters and lack of culturally aware service provision (Khatri and Assefa 2022). People from CALD backgrounds experiencing mental health conditions are also recognised as facing additional challenges and vulnerabilities in accessing health services owing to shame, stigma and misunderstanding (Khatri and Assefa 2022). The process of migration is an important social determinant of health and can affect health directly or indirectly, through changes to other social circumstances such as housing and living conditions (Castañeda et al. 2015). In addition, immigration is a consequence of social factors such as poverty, educational and employment opportunities, and persecution. The findings in this report are limited to the data sources used but provide an opportunity for future investigation into the social determinants of health.