Wider determinants, also known as social determinants, are a range of social, economic and environmental factors which affect people’s health. At every life stage, our health is determined by complex interactions between these different factors. Determinants of health include, but are not limited to, our environment, genetics, income and educational level, social support and access to healthcare services. Research shows that social determinants can be more important than health care or lifestyle choices in influencing health, with social determinants  accounting for as much as 30-55% of health outcomes (World Health Organisation, 2023).

Figure 1: Wider determinants of health. Source: Dahlgren and Whitehead. 

Unemployment

Unemployment is linked to increased stress-related illnesses such as high blood pressure, stroke, heart attacks, heart disease, and arthritis. Significant links have been found between unemployment and mental health problems including depression, anxiety and substance abuse. During the second quarter of 2024 there was an average number of 20 registered unemployed individuals, representing a 96% reduction in unemployment since the second quarter of 2012.

Economy

Health and Economy are inextricably linked. Poor health reduces levels of productivity and the size of available workforce. Additionally, the health of a country impacts the education system, and by extension, human capital.

• Gibraltar’s Gross Domestic Product (GDP) forecast for 2023/2024 is £2.91 billion – representing an increase in the size of the economy of around 5.8%.
• The minimum wage in Gibraltar is set to increase from £8.60 to £8.90 per hour.
• Average gross annual earnings increased by 5.7% from £34,105.45 in October 2022 to £36,050.21 in October 2023.

The relationship between health and economy

Housing

The quality of housing can have major implications for people’s mental and physical health. Health can be negatively impacted by over-crowding, poor insulation, presence of damp and mould, injury hazards, as well as accessibility  issues for people with functional impairments. Poor housing is linked to a wide range of health conditions including respiratory diseases, cardiovascular diseases, injuries, mental health issues and infectious diseases. Additionally, poor quality housing has been found to be the strongest predictor of emotional and behavioural problems in low-income children.

Gibraltar has a variety of housing stock and the Government of Gibraltar is committed to the provision of safe, affordable housing for sale as well as government rental stock. The number of applicants currently on the pre-waiting and waiting list for government housing in Gibraltar is increasing. Understanding demand for housing can help inform government plans for new housing stock and future local infrastructure, mitigating potential risks to health.

Education

Educational attainment is linked to health behaviours and outcomes throughout a person’s life. Research has found that individuals with significantly lower educational attainment are more likely to suffer from poor health. Individuals with higher levels of education are less likely to suffer from chronic diseases, report poor health or suffer anxiety or depression.

Remaining in education, employment or training after school is associated with a reduced risk of a range of negative mental and physical health outcomes. Education in Gibraltar is compulsory up until the age of 16 years old.

Our full findings on Education can be found here.

Gibraltar’s Assets

Community assets are collective resources which individuals and communities have access to. Examples of community assets include libraries, leisure centres, citizen information centres, green/blue space and charities. Assets include organisations, associations, and individuals.  These assets promote social inclusion and can improve the health and wellbeing of citizens. Gibraltar is an asset rich community which currently includes :

• 266 registered charities
• 14 HMGoG Schools, 4 Private Schools, 1 College and 1 University.
• 1 library.
• 1 museum & various sites of historic interest.
• 14 places of worship.
• Various Green spaces including  Common Wealth Park, Campion Park, Gibraltar Alameda Botanic Gardens and Alameda Wildlife Conservation Park, Upper Rock Nature Reserve, and the Europa Point Outdoor Interpretation and Green area.
• 7 beaches

Page last reviewed : July 2024