A Report on the Social Determinants of Health and their Alignment with the Sustainable Development Goals

Introduction: The River of Health Conceptual Model

The “River of Health” model provides a framework for understanding how a range of interconnected factors contribute to overall health outcomes. This model categorizes determinants into three distinct levels—Upstream, Midstream, and Downstream—illustrating that health is not merely the result of individual choices or clinical care, but is shaped by broader societal and environmental conditions. This holistic perspective directly aligns with the integrated nature of the United Nations Sustainable Development Goals (SDGs), which recognize that progress in health is contingent upon progress in other areas of development.

Upstream Determinants: The Foundational Role of SDGs

Upstream factors represent the fundamental causes that structure the opportunities and resources for health. These macro-level determinants are the primary drivers of health equity and are directly addressed by numerous SDGs.

• Socioeconomic and Political Context: This includes government policies on education, housing, and labor, as well as broader socioeconomic factors like poverty and social status. These are the headwaters that determine the river’s course.
  • SDG 1 (No Poverty): Directly addresses poverty as a fundamental barrier to health.
  • SDG 4 (Quality Education): Ensures educational policies create opportunities for better health literacy and economic stability.
  • SDG 8 (Decent Work and Economic Growth): Focuses on employment and economic conditions that support healthy lives.
  • SDG 10 (Reduced Inequalities): Aims to dismantle systemic inequalities that lead to health disparities.
  • SDG 16 (Peace, Justice and Strong Institutions): Promotes effective governance and policies essential for creating healthy societies.
• Physical Environment: This encompasses the quality of the natural and built environments, including pollution, climate change, and housing.
  • SDG 6 (Clean Water and Sanitation): A critical environmental determinant for preventing disease.
  • SDG 7 (Affordable and Clean Energy): Reduces air pollution and its associated health impacts.
  • SDG 11 (Sustainable Cities and Communities): Promotes safe housing and healthy urban planning.
  • SDG 13 (Climate Action): Addresses the overarching threat of climate change to global health.

Midstream Factors: Bridging Policy and Individual Health

Midstream factors are intermediate determinants that are shaped by upstream conditions. They represent the pathways through which social and environmental factors affect health at a more proximate level. These factors are central to the targets within SDG 3.

1. Healthcare Access and Quality: The availability, affordability, and quality of health services are critical. This directly corresponds to SDG 3, Target 3.8, which calls for achieving universal health coverage.
2. Health Behaviors: Actions such as diet, physical activity, and smoking are influenced by the socioeconomic and environmental contexts established upstream. For example, food deserts (SDG 2) or unsafe neighborhoods (SDG 11) limit healthy choices.
3. Psychosocial Factors: Stress, social support, and community cohesion are shaped by factors like job security (SDG 8) and social inclusion (SDG 10).

Downstream Outcomes: The Ultimate Measure of SDG Success

Downstream factors are the most immediate causes of poor health, representing the point at which individuals interact with the healthcare system. These outcomes are the culmination of all upstream and midstream influences.

• Disease and Injury: The incidence and prevalence of chronic diseases, infections, and injuries are the tangible results of the broader determinants.
• Health Outcomes: The final measures of a population’s health, including well-being, morbidity, and mortality rates.

The ultimate goal of the integrated SDG framework is to improve these downstream outcomes by addressing their root causes upstream. Achieving SDG 3 (Good Health and Well-being) is therefore dependent on the successful implementation of the entire 2030 Agenda, as conceptualized by the River of Health model.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being
• SDG 6: Clean Water and Sanitation
• SDG 11: Sustainable Cities and Communities
• SDG 13: Climate Action

Specific SDG Targets Identified

1. Target 3.3: End epidemics of water-borne diseases

   The article directly addresses this target by highlighting the “Increased Incidence of Waterborne Diseases” such as Cholera, Typhoid, Giardiasis, and Cryptosporidiosis as a primary consequence of climate change. It explicitly links climate-induced environmental changes to the spread of these communicable diseases.

2. Target 6.1: Achieve universal and equitable access to safe and affordable drinking water

   This target is relevant as the article identifies “Water Scarcity and Contamination” as a key mechanism through which climate change impacts health. The disruption of clean water sources is a central theme, directly opposing the goal of safe drinking water for all.

3. Target 6.2: Achieve access to adequate and equitable sanitation and hygiene

   The article points to the “Disruption of Water and Sanitation Systems” caused by extreme weather events like flooding. This directly undermines the goal of providing and maintaining adequate sanitation facilities, which are crucial for preventing waterborne diseases.

4. Target 11.5: Significantly reduce the number of people affected by disasters, including water-related disasters

   The article’s focus on “Extreme Weather Events (Flooding, Droughts)” and their consequences, such as “Economic Losses” and the fact that “Vulnerable Populations [are] Disproportionately Affected,” aligns with this target. It underscores the human and economic toll of climate-related water disasters.

5. Target 13.1: Strengthen resilience and adaptive capacity to climate-related hazards

   The entire article is framed around the impacts of climate change, with “Increased Temperature,” “Extreme Weather Events,” and “Sea Level Rise” being the root causes of the health crisis described. The issues discussed, such as “Health System Strain,” highlight a lack of resilience and adaptive capacity to these climate hazards.

Implied Indicators for Measuring Progress

1. Indicator for Target 3.3: Incidence of specific waterborne diseases

   The article explicitly mentions an “Increased Incidence of Waterborne Diseases” and lists specific examples (Cholera, Typhoid). Therefore, a direct implied indicator is the rate of new cases of these diseases per 1,000 or 100,000 population, which would be used to measure progress in combating them.

2. Indicator for Targets 6.1 & 6.2: Functionality and safety of water and sanitation systems

   The article’s mention of “Water Contamination” and “Disruption of Water and Sanitation Systems” implies that indicators would relate to the quality and reliability of these services. This could be measured by the percentage of the population with access to safely managed drinking water and sanitation services, especially after extreme weather events.

3. Indicator for Target 11.5: Economic and human impact of disasters

   The article points to “Economic Losses” and “Vulnerable Populations Disproportionately Affected” by climate-related events. This implies the use of indicators such as the direct economic loss attributed to disasters and the number of people affected (e.g., displaced, injured, or requiring assistance) by these events, particularly within vulnerable groups.

Summary of SDGs, Targets, and Indicators

Source: cureus.com