The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis

Objectives: To identify the impact of social determinants of health on physical and mental health outcomes in a UK population. Study design: Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6,208 responses). Methods: We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education, and income on a behaviour index (smoking, alcohol consumption, physical activity and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. Results: The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA=0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income, was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (p<0.001 in all cases). Conclusions: Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions which would influence behaviour, and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.