An Original Investigation into Social Determinants of Health and Health Inequity in Nigeria: Towards a Contextualised Theoretical Model

The social determinants of health framework developed by the WHO Commission on Social Determinants of Health provides a foundational model for understanding health inequity, but its empirical testing and contextualisation within Nigeria's ethnic diversity, political economy, and federalism have not been rigorously attempted. This study conducted an original investigation into social determinants of health and the theoretical adaptations needed for the Nigerian context. A multi-method theoretical and empirical approach was employed. Systematic review of 65 publications on social determinants of health in Nigeria (2015 to 2024) characterised the evidence base and identified theoretical gaps. Primary data collection involved a national cross-sectional survey of 2,400 adults across all six geopolitical zones assessing health outcomes against structural determinants including income, education, housing, social exclusion, gender inequality, and ethnic discrimination. Multi-level modelling examined zone-specific and community-level moderation of individual social determinant effects. Results showed substantial inter-zonal variation in the relative weight of social determinants, with income being the dominant predictor in southern zones and ethnic marginalisation being comparably important in northern zones. Gender-based power dynamics explained health outcome variation in all zones but through different mechanisms. The original Nigerian Social Determinants of Health Model proposes five adaptations to the standard CSDH model: political economy of federalism as a health equity structural driver, ethnic stratification as a distinct social determinant pathway, religious community as a social capital determinant, gender-power interaction as a health determinant mechanism, and informal economy welfare as a social protection determinant.