Contents lists available at ScienceDirect Health & Place journal homepage: www.elsevier.com/locate/healthplace The experience of social determinants of health within a Southern European Maltese culture Bernadine Satariano a, ⁎ , Sarah E. Curtis b,c a University of Malta, Junior College, Malta b Durham University, United Kingdom c University of Edinburgh, United Kingdom ARTICLE INFO Keywords: Mediterranean model Family Social norms Malta ABSTRACT This study contributes to international research on geographies of health and wellbeing in Mediterranean cultures. The paper draws upon evidence from qualitative research in three localities in Malta, a country where previous research on this topic is quite limited. Through in-depth interviews with people from some of the most disadvantaged and socially marginalised groups in Maltese society, this research illustrates how psychosocial health and wellbeing of the inhabitants within this Mediterranean region are strongly influenced by wider social determinants, particularly the powerful dynamics of social norms involving roles of extended family, traditional attitudes towards marriage as an institution, family honour, gender roles and religious beliefs and practices. This research explores how these social determinants of health within a Maltese context are complex and contingent on personal and local socio-geographical conditions, so that while for some individuals they are beneficial for health and wellbeing, for others the effects are detrimental. The discussion considers how to interpret the ‘Mediterranean model’ of social determinants of health in light of the experiences of this group of inhabitants. 1. Introduction This paper examines how social and cultural processes operate as ‘wider social determinants’ of health (WHO, 2008) in parts of Malta and how they influence health of individuals. The ‘wider social determinants’ of particular interest in this paper include processes involving social norms linked to familial, economic, political and institutional structures, which are often beyond the individual's control (McKeown, 1979; Evans et al., 1994; Marmot and Wilkinson, 2006). These wider determinants are likely to operate variably across Maltese society, and this paper will focus on selected settings to show how their impacts on individual health are contingent on attributes of individuals and the places where they live. This paper therefore contributes to international research in health geography that demonstrates how wider social determinants are mediated by local neighbourhood con- ditions and may impact variably on different groups of people. It has been argued that health determinants can be interpreted as operating in a relational manner that depends on the variable interaction between diverse individual and environmental attributes in different temporal and spatial settings (Macintyre et al., 1993; Pickett and Pearl, 2001; Cummins et al., 2007; Curtis, 2010; Gattrell and Elliot, 2015). A large body of theoretical and empirical research has focussed on the social determinants of health and neighbourhood processes within Northern European and North American contexts (Macintyre et al., 1993; Pickett and Pearl, 2001; Curtis, 2010; Gattrell and Elliot, 2015). The World Health Organisation defines the social determinants of health as ‘the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life’ (WHO, 2015 p.1). Moreover, social determinants are influenced by social norms; generally accepted behaviours, recognized by common customs, procedures and rules and form basis for arbitration in social relations (Baron, 2004). Such norms help to build social cohesion (Hechter and Opp, 2004), and may help to prevent deviant behaviour (Horne, 2004). Norms are encouraged by mechanisms including sense of guilt, and social penalties causing shame, exclusion and punishment, operating in the social networks to which people belong (Foley and Edwards, 1998; Leavitt and Saegert, 1990; Hammond and Axelrod, 2006). This paper is situated in the literature (summarised below) suggesting that important social determinants of health in Southern European (‘Mediterranean’) cultural contexts today may be distinctive because of the persistence of particular social and cultural processes prevailing in these societies that influence social norms. https://doi.org/10.1016/j.healthplace.2018.02.011 Received 20 November 2017; Received in revised form 25 January 2018; Accepted 27 February 2018 ⁎ Corresponding author. E-mail address: Bernadine.satariano@um.edu.mt (B. Satariano). Health & Place 51 (2018) 45–51 1353-8292/ © 2018 Elsevier Ltd. All rights reserved. MARK