Social factors influencing health is an essential part of social responsibility in health, as various factors (genetic, demographic, cultural, and socio-economic) beside the medical framework determine the health condition of a population. The latter should be considered as a social project, in constant evolution, that takes into account not only the parameters related to the health system, but also the living conditions of the populations. Currently, it is well established that social determinants intervene as well as the quality of the health system in both the health situation and life expectancy of the population.

However, the list of social factors that influence health is constantly growing and the term itself might be unclear for various reasons. This paper discusses briefly the social factors as crucial determinants in the topic of health and focuses on some confusion related to it.

Currently, “social determinants of health” are regarded as a crucial concept for overall public health [1] and requires a clear understanding for better populations’ health management. Both the World Health Organization (WHO) and the World Conference on Social Determinants of Health do play an great role in emphasizing this concept. In fact, in order to address health issues effectively and develop concrete solutions, these determinants should be taken into consideration, and integrated in an approach that goes beyond care and treats the patient as a whole. The WHO defines these social factors as conditions in which people are born, live, grow, work, and age. These conditions are determined by social, economic and even political parameters [2] That is to say that socio-economic and political conditions should guarantee access to fairly distributed social resources, among the population, such as healthcare, education, nutrition, healthy surroundings, are some of those resources.

However, the list of social factors is constantly growing. Since beside the classical well-established parameters such as education [3], living environment, income, work, food, transport [4] that are suggested to be considered as “elementary” by some authors and thus require priority for policy interventions, more recent literature reports other determinants. Culture, religion and social norms [5], Health system, sexual orientation, gender, discrimination, safety, conflict, racism, immigration, family, religious beliefs and marginalization [6] do also account for social factors of health. Moreover, Strazdins et al. [7] also includes “time” in the list of social factors influencing health, as healthy attitudes and behaviors, accessing health services and resting do require time. These considerations rise also the reflection as to which extent a health professional should focus on each and every determinant, which and why ones should be given priority [1].

Noteworthy, that all these social factors of health are related to public policies [1]. Therefore, the latter itself, represents a very important determinant than the more often discussed social factors of health such as living environment, education and employment [8].

Nonetheless, The term “ social determinants of health ” is potentially confusing for various reasons. Firstly, there is no acknowledged list that defines social determinant of health accurately [1]. The term “social” is unclear [9] and hard to define precisely. Moreover, the ever-growing list of determinants may discourage practitioners to focus on seeking social factors and therefore referring patients to support services if needed. In fact, ambiguity and the continuously increasing list of social factors impacting health are the central reasons for the significantly variable content of social determinants list in the literature. Furthermore, this confusion could lead to the assumption that health inequalities can be decreased by policies that pay particular attention to the social determinants of health [10] which is reductive for the whole concept.

Besides, the main concept of social factors influencing health itself can be misleading, as it refers, according to Graham, to both the factors determining health and those determining inequalities in health [11]. Consequently, it has been suggested to modify the term into a more accurate one, such as “social determinants of health and related inequalities” [12]. Therewith, the existing confusions should be eliminated to guarantee a good comprehension of the concept “social determinants of health”, as it is critical for all involved actors including the general public in order to work efficiently on improving the health and well-being of populations worldwide [1].

IH and MG discussed the idea of producing this opinion piece and wrote the manuscript.