The Missing Dimension in Population Health

Integrating Affective Determinants of Health with Social Determinants

Population health, at its core, is about understanding and addressing the multitude of factors that influence health outcomes across specific populations. Since the early 2000s, the spotlight has been on social determinants of health (SDOH)—external factors ranging from housing stability to education levels. These indicators, while profoundly impactful, form only 20% of what impacts a patient’s health.


To truly understand health disparities and their root causes, we need to dive deeper, beyond just the external markers. This is where affective determinants of health (ADoH) come into play. ADoH focuses on the internal emotional and psychological states that further dictate an individual’s health, and are the earliest indicators of health behavior which accounts for at least 40% of our overall health. While historically overshadowed by the once more tangible SDOH, ADoH’s significance is now gaining the clinical recognition it deserves.

Imagine the intersection of socio-economic challenges and mental health. Studies highlight that individuals living in socio-economically disadvantaged areas are twice as likely to develop depressive disorders. Such statistics underline the intertwined nature of mental well-being with our external environment. 

Consider the staggering reality: those at the lowest income levels in a community experience depression, anxiety, and other mental illnesses up to three times more frequently than those at the top echelons.

In addition, the concept of resilience further underscores the intricate relationship between internal and external determinants. An individual’s ability to bounce back from adversities profoundly impacts their health trajectories. Numerous investigations, such as the study authored by Tecson and colleagues, have highlighted the potential of resilience in reducing the risk of chronic diseases. Considering this, ADoH factors like resilience aren’t merely about mental fortitude; it’s a direct contributor to our overall health.

Lastly, let’s discuss the importance of community and social bonds in our emotional well-being and overall health. A study by Harvard School of Public Health found that isolated individuals face a 50% greater risk of experiencing premature death. Given the growing challenges of isolation and loneliness in today’s world, the impact on health is undeniable.

When we consider their interconnected nature, it’s evident that to holistically address population health, a dual focus on both SDOH and ADoH is critical. By combining the two, we are able to provide an enriched perspective that recognizes that human health isn’t just shaped by external factors but is deeply intertwined with our emotional and psychological states.

 As we stand on the cusp of healthcare’s future, the call is clear: integrate these determinants for a truly inclusive and patient-centered approach. In doing so, we unlock the potential to comprehend the comprehensive spectrum of health and design interventions that genuinely align with the multifaceted needs of our communities.