Social determinants of health

Evidence supports the close relationship between people’s health and the living and working conditions which form their social environment (Baum 2018; Wilkinson and Marmot 2003). Factors such as socioeconomic position, educational attainment, conditions of employment, the distribution of wealth, empowerment and social support – together known as the social determinants of health – can act to strengthen or undermine the health of individuals and communities.

The World Health Organization (WHO) describes social determinants as ‘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’ (WHO 2023).

Social determinants form part of the wider determinants of health which also include the environmental, cultural, biomedical, commercial and digital factors in our lives (Department of Health and Aged Care 2021).

According to the WHO, social determinants of health account for between 30–55% of health outcomes. They have an important influence on health inequities – the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income – including Australia – health and illness follow a social gradient: the lower the socioeconomic position, the worse the health (WHO 2023).

This page includes selected data to monitor key social determinants of health in Australia. In addition to social determinants, there are other types of health determinants, such as the built environment and the natural environment.

For more information, see What are determinants of health?

Income, education, occupation

In general, every step up the socioeconomic ladder is accompanied by a benefit for health. The relationship is two-way – poor health can be both a product of, and contribute to, lower socioeconomic position (Kawachi et al. 2010).

Income, educational attainment and level of occupation are 3 social determinants of health that are commonly used to measure socioeconomic position. Widening inequalities in these determinants are often used to help explain widening health inequalities (Flavel et al. 2022). How determinants affect health inequalities is discussed further in What are determinants of Health?

In Australia, data on income, education and occupation show that:

• around 10.5% of the population lived in low-income households (defined as equivalised disposable household income that is less than 50% of the national median) in 2017–18. This rate has fluctuated between 9.3% and 13.6% since 2003–04 (ABS 2022b; AIHW 2018) (Figure 1)
• in 2023, an estimated 69% of people aged 25–64 held a non-school qualification at Certificate III level or above, an increase of 9 percentage points since 2014. The gap between males and females has closed in recent years (ABS 2023a) (Figure 1)
• among major occupation groups, Managers had the highest average weekly total cash earnings in 2021 ($2,596), and Sales workers the lowest ($761) (ABS 2022a). The average weekly total cash earnings for Managers was 3.4 times as high as for Sales workers in 2021, compared to 3.5 times as high in 2016 ($2,298 and $652), and 3.2 times as high in 2012 ($1,926 and $607)
• income inequality among Australian households (measured by the Gini coefficient for equivalised disposable household income – see glossary) was 0.324 in 2019–20, relatively unchanged from the 2009–10 value of 0.329. Income inequality among households varied across areas, from 0.275 in Tasmania excluding Greater Hobart (lower inequality) to 0.340 in Greater Sydney (higher inequality) (ABS 2022b).

For more information, see Income and income support and Higher education, vocational education and training. 

Figure 1: Selected social determinants of health, by disaggregation and period

Employment and work

The psychosocial stress caused by unemployment has a strong impact on physical and mental health and wellbeing. Once employed, participating in quality work helps to protect health, instilling self-esteem and a positive sense of identity, while providing the opportunity for social interaction and personal development (Commission on the Social Determinants of Health 2008). In Australia:

• the proportion of the population aged 15–64 who are employed (employment-to-population ratio) has fluctuated over the last 15 years, from 72.4% in January 2007 to a low of 69.5% in May 2020 (reflecting the effects of COVID-19) to 77.3% in December 2023. Over the same period, the unemployment rate fluctuated from 4.6% in January 2007 to a high of 7.8% in July 2020 (reflecting the effects of the COVID-19 pandemic) and a low of 3.5% in October–November 2022, with a rate of 3.9% in December 2023 (ABS 2024)
• in December 2023, 1 in 15 (6.8%) employed people aged 15–64 were underemployed (not working the hours they would like to, and available to work) – 5.5% and 8.3% of the male and female labour force, respectively (ABS 2024)
• in June 2023, there were 69,000 jobless couple families with children aged 0–14 (3.1% of all couple families with children aged 0–14), down from 93,000 (4.7%) in June 2013. There were 146,000 (27%) jobless one-parent families with children aged 0–14 in June 2023, down from 203,000 (41%) in June 2013 (ABS 2023c) (Figure 1).

For more information, see Employment and unemployment.

Housing and homelessness

Access to appropriate, affordable and secure housing can limit the physical and mental health risks presented by factors such as homelessness and overcrowding (Baker and Bentley 2023).

Evidence also supports a direct association between poor-quality housing and health consequences such as respiratory illness, cardiovascular disease and poor mental health (Baker et al. 2016). Young people, Aboriginal and Torres Strait Islander (First Nations) people, people with long-term health conditions or disability, people living in low-income housing, or people who are unemployed or underemployed are at greater risk of living in poor-quality housing.

In Australia:

• more than 122,000 men, women and children, or 48 people per 10,000 population, were estimated to be homeless on the night of the 2021 Census of Population and Housing, a similar rate to 2011 (ABS 2023b) (Figure 2). For more information, see Homelessness and homelessness services and Health of people experiencing homelessness
• 42% of lower-income households (see glossary) were in rental stress in 2019–20, spending more than 30% of their gross weekly income on housing costs. In 2007–08, 35% of lower-income households were in rental stress (ABS 2022c) (Figure 2). For more information, see Housing affordability
• in 2019–20, 1 in 26 households (3.8%) were overcrowded, based on those households needing one or more extra bedrooms (ABS 2022c). Higher rates are found among First Nations people, although available data suggest a decline in overcrowding over time – from 31% in 2001 to 19% in 2021 (AIHW 2023b). For more information, see Housing circumstances of First Nations people.

Figure 2: Housing and homelessness, by disaggregation and period

Early childhood

The foundations of adult health are laid in-utero and during the early childhood period. Physical, social/emotional and language/cognition development in early childhood strongly influence school success, economic participation, social citizenship and health (van Eyck et al. 2023). In Australia:

• around 334,400 children aged 4–5 were enrolled in a preschool program in 2022. Twenty-one per cent of all children enrolled in a preschool program resided in the least disadvantaged areas while 17% resided in the most disadvantaged areas (ABS 2023d)
• in 2021, 63,300 children entering primary school (22%) were developmentally vulnerable (see glossary) on one or more Australian Early Development Census (AEDC) domains, compared with 58,000 (24%) in 2009. In 2021, children living in the lowest socioeconomic areas were more vulnerable than children living in the highest socioeconomic areas (33% and 15% respectively) (AEDC 2022).

For more information, see Early childhood and transition to school.

Family relationships

Family can influence a person’s physical and mental health in a number of ways, including through creating a safe and supportive emotional and learning environment, and through providing access to services, products and activities.

As with other health determinants, the effects can range from potential benefit in positively functioning and supportive families to potential disadvantage in families with abuse or neglect. In Australia, data on family relationships highlight that:

• 89% of all families with children aged 14–15 rated their family cohesion as good, very good or excellent in 2016–17 (91% for couple families, 81% for one-parent families) (AIHW 2022)
• children who have been abused or neglected often have poor social, behavioural and health outcomes in childhood and later life. In 2020–21, the rate of children and young people aged 0–17 who were the subject of a child protection substantiation was 8.8 per 1,000, an increase from 6.2 per 1,000 in 2010–11 (AIHW 2022)
• in 2021–22, 1 in 6 women (17% or 1.7 million) and 1 in 18 men (5.5% or 527,000) had experienced violence (physical and/or sexual) by a current or previous cohabiting partner since the age of 15 (AIHW 2023a). 

For more information, see Family, domestic and sexual violence.

Social inclusion

Social inclusion and the degree to which individuals form close bonds with others outside the family has been linked in some studies to lower morbidity and increased life expectancy. Strong social networks may benefit physical and mental health through practical and emotional help and support, and through networks that help people find work or cope with economic and material hardship. In Australia, data on social connectedness highlight that:

• around 1 in 5 people report that they often felt very lonely – 16% of males and 19% of females aged 35 and over in 2021, compared with 20% of males and 23% of females aged 35 and over in 2001 (AIHW 2023c)
• in 2020, most people aged 15 and over (93%) reported being able to get support in times of crisis from people living outside their household, similar to 2010 (94%) (AIHW 2021). People with a mental health condition were less likely than those who do not have a mental health condition to report being able to get support (85% and 94%).

Social exclusion is a term that describes social disadvantage and lack of resources, opportunity, participation and skills which are essential for full participation in society (see glossary). Social exclusion through discrimination or stigmatisation can cause psychological damage and harm health through long-term stress and anxiety. Poor health can also lead to social exclusion. In Australia:

• 1 in 4 people aged 15 and over (25%, or 5 million people) experienced some degree of social exclusion, with 6.0% (1.2 million) experiencing deep social exclusion, including 1.3% (260,000) who experienced very deep social exclusion in 2018 (Brotherhood of St Laurence and MIAESR 2020). The prevalence of deep social exclusion has remained steady since 2009, when it was 5.5%.
• 54% of people aged 15 and over who had a long-term health condition or disability experienced some level of social exclusion, with 16% experiencing deep social exclusion in 2018 (Brotherhood of St Laurence and MIAESR 2020).

For more information, see Social isolation, loneliness and wellbeing.

Where do I go for more information?

For more information on social determinants of health, see:

• Australia’s health 2020: data insights article, Social determinants of health in Australia
• Australia’s welfare topic summaries
• World Health Organization Social determinants of health

For more on this topic, see Social determinants.