Psychosocial pathways and health outcomes: Informing action on health inequalities

Unequal distribution of the social determinants of health, such as education, housing and employment, drives inequalities in physical and mental health. There is also extensive evidence
that ‘psychosocial’ factors, such as work stress, influence health and wellbeing.

The term ‘psychosocial’ relates to the way that social factors affect states of mind.

This report highlights the current evidence that exists about the relationships between social determinants, psychosocial factors and health outcomes. It also provides a conceptual
framework that focuses on the psychosocial pathways between factors associated with social, economic and environmental conditions, psychological and psychobiological processes, health behaviours and mental and physical health outcomes

The mind is a gateway through which conditions of daily life affect health. Social and material conditions of daily life act through the mind to affect wellbeing and health – this is what is meant by psychosocial pathways. Therefore, psychosocial pathways are an important part of the framework of causes that lead from social determinants to inequalities in wellbeing and health. However, the breadth of this causal framework, in particular the influence of psychosocial pathways, is not often explicitly recognised in policy and practice.

The Institute of Health Equity, commissioned by PHE, has produced a series of evidence reports on local action to reduce health inequalities in England through action on the social determinants of health, including the areas of early years experiences, education, employment, living wage, fuel poverty, access to green spaces and the built environment. A related report on local action to tackle social isolation was published in 2015. A connecting thread across these reports is the importance of psychosocial pathways to wellbeing and health.

While psychosocial pathways have been highlighted as important, stakeholders have identified a ‘lifestyle drift’, where public health interventions have become focused on changing individual behaviours and do not fully integrate the effects of living conditions and psychosocial contexts. There is evidence that such person-based interventions, focused on prompting changes among individuals, may inadvertently widen inequalities, at least in the short term, because advantaged groups are usually in a better position to make healthy behaviour choices than the rest of the population. In addition, the evidence shows that psychosocial factors influence health in ways other than individual behaviours – via stress pathways. For example, stress associated with adverse experiences in childhood sculpts the brain and affects child development, life chances and health across the life course.

This report collates and synthesises evidence about psychosocial concepts and pathways to health and wellbeing, which will help to inform action on health inequalities that addresses the full complexity of causal pathways on health and wellbeing. This discussion is therefore wider than psychosocial influences on individual behaviours: it is about multiple factors outside the control of individuals that can have adverse or protective effects on people’s lives and mental health and wellbeing via psychosocial pathways that impact on overall health. Therefore the emphasis is on the need to address the whole of the social determinants pathway in which psychosocial pathways are situated. This includes protective factors, such as social support, and protective influences organised in schools, neighbourhoods and work places.