The social determinants of health



Alcohol and other drug (AOD) use is a health issue. The same factors that may lead to someone developing a preventable disease, experiencing obesity, or developing a depressive disorder also influence the likelihood of AOD misuse.

The good news is that when we build strength and capacity in communities, all of these factors are positively affected, leading to improved health outcomes across the community.

This is the goal of primary prevention – to improve health outcomes by addressing the specific risk and protective factors at play within the social determinants of health that are affecting a given community.

Social determinants of health

A person’s health is determined by more than just the individual decisions they make. It’s also shaped by the social, cultural and environmental context they’re born, raised, and live in – what are called the ‘social determinants of health’.

Things like socio-economic class, gender, ethnicity, level of education, occupation, income, housing and transport are examples of social determinants of health.

The relationship between social determinants and health outcomes isn’t linear, because every community is different.

That’s also why the community itself is well placed to make decisions about what their community needs – to identify strengths to draw on and barriers to overcome.

Learn more about the social determinants of health.

Risk and protective factors

Understanding the social determinants of health helps us look at different levels – societal, community, family, and individual – and identify ‘risk and protective factors’. These are factors that influence a variety of health outcomes, of which AOD misuse is one.

Programs that target the most relevant risk and protective factors to their specific community will be the most effective. This is also why we believe that consultation with community members, and their involvement in program design and implementation, creates better programs.

It’s never just one factor that leads to a negative health outcome.

But some factors might be more prevalent in your particular community and therefore worth concentrating on. Note that risk and protective factors are independent and not simply opposites of each other.

People can have a combination of risk and protective factors within their lives at any time so the effect of any single factor is not decisive. Risk factors are most powerful when they accumulate so people in greatest jeopardy are people who are subject to several risk factors simultaneously. Just because someone experiences risk factors does not definitely mean they will misuse AOD – and vice versa.


Risk factors

  • personal temperament (impulsive, aggressive)
  • childhood conduct disorder (e.g. aggression)
  • fetal alcohol spectrum disorder

Protective factors

  • personal temperament (shy, cautious)
  • developing social skills – positive relationships with family and friends, teachers, etc.
  • emotional control – learning conflict resolution, stress-coping mechanisms


Risk factors

  • poor parenting skills
  • child abuse and neglect
  • family breakdown (e.g. parent separation)
  • role-modelling of negative personal relationships
  • lack of family support in school and leisure activities
  • parent-child conflict, lack of conflict resolution skills
  • negative lifestyle role-modelling

Protective factors

  • positive relations with parents and other family members
  • role-modelling of healthy behaviours
  • supportive attitudes towards education, school completion


Risk factors

  • school failure
  • alienation from school
  • lack of positive and supportive interaction with adults
  • social isolation

Protective factors

  • staying at school
  • enjoying school
  • succeeding at school
  • rewards for prosocial involvement for example Best and Fairest, volunteer award, etc.


Risk factors

  • lack of amenity, few leisure activities
  • lack of attachment to neighbourhood and broader community
  • community disorganisation,
  • availability and use of AOD perceived and actual level of community AOD use and availability social disconnection between community members

Protective factors

  • attachment to adult role models outside home – e.g. teachers, sport coaches, youth leaders
  • development of future oriented recreational pursuits for example – music, sport, arts etc.
  • communities that are free of AOD, or free of visible AOD use
  • opportunities for engagement with broader community – having a sense of belonging


Risk factors

  • extreme social disadvantage
  • institutional racism
  • high levels of inequality
  • lack of employment opportunities
  • social attitudes to health (drinking culture, work-life balance expectations, attitudes towards nutrition and lifestyle)
  • civil conflict
  • natural disasters (e.g. bushfires)

Protective factors

  • regulation of AOD availability
  • social inclusion, equality of opportunity
  • social norms towards AOD
  • social attitudes to health (drinking culture, nutrition, lifestyle)

Roche A, Kostadinov V, Fischer J, Nicholas R, (2015), ‘Evidence review: The social determinants of inequalities in alcohol consumption and alcohol-related heath outcomes’, Report for VIC Health.

Australian Medical Association, (2007), ‘Social Determinants of Health and the Prevention of Health Inequalities’.

World Health Organisation Europe, (2003), ‘The Solid Facts’ second edition.

Marmot, Michael, (2016), Health inequality and the causes of the causes, 2016 Boyer Lectures. [podcast] s.l.:Australian Broadcasting Corporation.

Holder, H, Treno, A, and Levy, D, (2005), Community Systems and ecologies of drug and alcohol problems. [ed.] T Stockwell, et al. Preventing harmful substance use: the evidence base for policy and practice. s.l. : John Wiley &sons, pp. 149-161.

Thomas, D, (2001), Health nutrition and economic propsperity: a microeconmic perspective, CMH Working paper series paper No: WGI:7.

Munro, G, and Ramsden, R, (2013), Primary Prevention: Preventing Uptake of Drugs In Ritter, A, King, T, and Hamilton, M (Eds.) Drug Use in Australian Society (pp. 135-168) South Melbourne, VIC: Oxford University Press.