Table 1.

Summary of Raphael’s (2011) seven discourses of the social determinants of health (SDH).

Discourse Level	Key Point
One: SDH as identifying and supporting those in need of health and social services.	Identifying and targeting those at greatest need through service provision.
Two: SDH as identifying those with modifiable medical and behavioural risk factors.	Identifying behavioural risk factors (e.g., diet, physical activity, alcohol and tobacco use) and promoting positive ‘lifestyle choices’.
Three: SDH as indicating the material living conditions that affect health.	Living conditions/circumstances affect health and choices either directly or indirectly through interrelated material, psychological and behavioural effects.
Four: SDH as indicating material living circumstances that differ as a function of group membership (class, gender and race).	Different (potential) axes of inequality can interact/intersect and compound each other to change people’s experience of the SDH.
Five: SDH and their distribution result from public policy decisions made by governments and other societal institutions.	Public policy can create and maintain (or reduce and disrupt) the SDH.
Six: SDH and their distribution result from economic and political structures and justifying ideologies.	Political and economic structures shape policy decisions.
Seven: SDH and their distribution result from the power and influence of those who create and benefit from health and social inequalities.	Individuals and groups shape policy that protects and benefits them at the expense of others (e.g., tax structures that favour the wealthy).