Affective Determinants of Health (ADoH): A Conceptual, Evidentiary and Mechanistic Framework

Persistent negative feelings such as stress, loneliness, fatigue, pain, irritability, anxiety, anddepressed mood are more than temporary discomforts. When they endure, even at subclinicallevels, they predict disease, disability, and premature mortality as strongly as many traditionalmedical and social risks. Yet decades of evidence have not yet been organized into a frameworkthat recognizes these states as determinants of health in their own right. This article advances theconcept of Affective Determinants of Health (ADoHs), a category parallel to SocialDeterminants of Health (SDOH). We define affectivity as the systemic capacity to feel, affects asits phenomenal instances, and affective determinants as the subset of affects that meet criteria fordeterminant status.A novel contribution of this framework is the recognition that persistent affects function not onlyas indicators of strain, suffering, and distress, but as stressors themselves, producing cumulativebiological and psychosocial strain. To explain their operation, we introduce a Three-ChannelModel of biological, behavioral, and coping pathways and describe the construct of cumulativeaffective load, which parallels allostatic load. By consolidating diverse evidence, we argue thatsystematic recognition of ADoHs as transdiagnostic determinants can improve early detection,prevention, and intervention across clinical care, population health, workplaces, education, andpolicy. Recognizing ADoHs highlights both the costs of neglect and the opportunity to addressthe affective foundations of health, equity, and human functioning.Keywords: affective determinants of health, affectivity, social determinants of health (SDOH),emotion, health disparities