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Social Holistic models of health and wellbeing

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Social and emotional wellbeing

The social determinants of health

Some of the variations in older people’s health are related to their individual characteristics (e.g. gender, age, genetics, culture) and their behaviours.  However, the conditions in which we are born, grow, live, and age, fundamentally determine our health and wellbeing (WHO 2021).  These conditions include our physical environment, access to education, housing, food, employment, finances, healthcare and social support (AIHW 2022a).  Our culture and social context, past and present social conditions (including social inclusion, freedom from discrimination and conflict) also play an important role in the health and wellbeing of individuals and communities (WHO 2003).  These are often referred to as the social determinants of health.

People’s experiences are shaped by the determinants of health – strengthening or undermining the health of individuals and communities (AIHW 2016).  A person’s environment, social circumstances and personal characteristics all have long term effects on how they age.  People’s health and function naturally changes with age, so the impact of ageing itself is also an important consideration.

Understanding the social determinants of health, can help us understand how people’s diverse characteristics and experiences may impact on their individual:

  • understanding, expectations and beliefs around health, ageing and care
  • sense of safety
  • ability and resources
  • perceptions of services
  • sense of empowerment, self determination, self efficacy and agency
  • help seeking behaviours
  • participation in services.

Australian Institute of Health and Welfare (AIHW) (2022a) Social determinants of health.  Available from:

Australian Institute of Health and Welfare (AIHW) (2022b) Determinants of health for Indigenous Australians.  Available from:

Marmot, M. & Allen, J. (2014) Social determinants of health equity. American Journal of Public Health, Vol. 104, S4. Available from:

World Health Organization (WHO) (2021) Ageing and health.  Available from:

World Health Organization (WHO) (2003) Social determinants of health: The solid facts (second edition).  Available from:

Let’s Learn Public Health (2017) Social determinants of health – an introduction (video).  Available from:

Commission on Social Determinants of Health (2008) Closing the gap in a generation: health equity through action on the social determinants of health – Final report of the commission on social determinants of health, World Health Organization (WHO).  Available from:

World Health Organization (WHO) (2022) Social determinants of health.  Available from:

Wilkinson, R. and Marmot, M. (eds) (2003) The social determinants of health. The solid facts, 2nd edn, WHO Europe.  Available from:

Baum, F. (2018) People’s health and the social determinants of health.  Health Promotion Journal of Australia, 29(1)8–9.  Available from:

Yuill, C., Crinson, I., & Duncan, E. (2010) Key concepts in health studies.  SAGE Publications Ltd.  Available from:

The following organisations have created useful resources to support providers understand the social determinants of health:

Social model of disability

The social model of disability says that disability is caused by the way society is organised, rather than a person’s impairment or difference.  The social model of disability encourages the need to look for ways of identifying and removing barriers so that people with disabilities are included and can fully participate in all aspects of life.  A range of barriers may exist in society, including physical barriers, communication, or attitudinal barriers.  For example, the “attitude” that people with disability cannot think and decide for themselves; may result in an intake worker not asking the person with a disability what goals they want to achieve through social support.  “When barriers are removed, people with disability can be independent and equal in society, with choice and control over their own lives” (AFDO 2022).

The following organisations have created useful resources to support providers understand the social model of disability:

The rights of older people

Compass. Ageism.  Available from:

Older Persons Advocacy Network (OPAN) Support for professionals: Older people’s rights.  Available from:

Australian Commission on Safety and Quality in Health Care (ACSQHC) (2020) Australian charter of healthcare rights (2nd edition). Available from:

UN General Assembly (1966) International Covenant on Economic Social and Cultural Rights (ICESCR) article 12(1).  Available from:

Australian Association of Gerontology (AAG) and the Aboriginal and Torres Strait Islander Ageing Advisory Group (ATSIAAG) (2020) Yarns on the (Virtual) Veranda.  Available here.

The Australian Human Rights Commission (AHRC) have a range of fact sheets and resources that describe multiple forms of discrimination and the work being undertaken to address them.  Further information is available from:  Of particular interest may be:

The World Health Organisation (WHO) support a range of programs and initiatives that support a rights based approach to health.  Further information is available from their website:

Equity, equality and inclusion resources

The principles of equality and equity both seek promote the concepts of fairness and justice.  It’s important to recognise however, the differences in each approach.

  • Equality – everyone is treated the same (i.e. everyone is provided with the same resources)
  • Equity – everyone is treated fairly based on their needs (i.e. each person is provided with the resources they require to succeed)

While providing everyone with the same resources may seem fair, this approach does not take into account the difference in people’s needs.  Equity acknowledges that everyone has different needs, experiences, and opportunities.  People from marginalised groups often experience more barriers when accessing and using services.  Therefore, they may need different resources or support to have the same opportunity to succeed.

Sydney Local Health District (2017) A framework for improving health equity in Sydney Local Health District: Opportunity for all.  Available from:

Canadian Medical Association (2013) Health equity and the social determinants of health. Available from:

Australian Institute of Health and Welfare (AIHW)  METEOR: Equity. Available from:

Mlaba, K. (2021) Equity vs Equality: What’s the Difference?  Available from:

Agency for Healthcare Research and Quality (2021) Six Domains of Health Care Quality.  Available from:

Hirschhorn L, R., Magge, H. & Kiflie, A. (2021) Aiming beyond equality to reach equity: the promise and challenge of quality improvement.  British Medical Journal 374:n939.  Available from:

Dzau, V.J., Mate, K. & O’Kane, M. (2022) Equity and Quality—Improving Health Care Delivery Requires Both. JAMA 327(6):519–520. Available from:

Equity vs equality imagery

Valbrun, V. (2017) Equity vs. Equality: Eliminating Opportunity Gaps in Education.  Available from:

Froehle, C. (2016) The Evolution of an Accidental Meme – How one little graphic became shared and adapted by millions (includes multiple visual representations of equality and equity). Available from: