[Answered] The elusive nature of social determinants has traditionally drawn policymakers towards the short-lived and inefficient technocratic solutions to mass health issues. Highlight the social determinants of health and challenges in their adoption as a solution to mass health issues.

The Social Determinants of Health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

Examples of the social determinants of health, which can influence health equity

• 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.
• Access to affordable health services of decent quality.

WHO suggests that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.

However, there are challenges in the adoption of Social Determinants of health in improving health outcome.

• Largely individual focused approach: The focus of Indian public health remained on improving health through healthcare institutions and personnel. The impetus was ­exclusively on mater­nal and child health and infectious diseases for too long. Which lacked a population-based approach.
• Lack of long-term approach: In an under ­resourced system like India, actions are taken that have more visibility and are easy to relate to outcomes. The elusive nature of social determinants has made it less attractive for policy makers.
• Lack of understanding of benefits: The flawed perception that social action for health is something feasible only for affluent countries.
• Lack of health in all policies approach: Policy making in India w.r.t to healthcare is in silos, improving social determinants of health will require a dedicated “health in all policies” approach. It also requires a focus on policies and practices in non-health sectors that impact health and health equity.

However, over the last decade, the Government has been working on translating the SDH framework into practice, with key interventions in the areas of:

• Nutrition (National Nutrition Mission)
• Drinking water (Jal jeevan Mission)
• Indoor air pollution (Ujjwala Yojna)
• Sanitation (Swachh Bharat Yojana)
• Gender equality (Beti Bachao Beti Padhao)

Adopting Social Determinants of Health (SDH) approach in addressing mass health Issue would require a dedicated approach of Health in all policies along with a dedicated study into the implication of SDH in India to guide policy making.