Time Is a Social Determinant of Health, Researchers Argue

Time is something public health research measures constantly—the timing of disease onset, the duration of exposure, the years of life lost to illness—yet rarely questions. A new argument published in SSM – Population Health contends that this blind spot is costing the field dearly. Berta Valente, the paper’s author, argues that time should be explicitly recognized as a socially structured determinant of health, one that shapes agency, dignity, and the unequal distribution of disease across populations. Far from being a neutral container in which health events simply occur, time is produced by social institutions, distributed unevenly across social groups, and experienced in profoundly different ways depending on where people stand in the social hierarchy.

The World Health Organization’s definition of health as a state of complete physical, mental, and social well-being has driven decades of frameworks built around the social determinants of health. Income, education, housing, and employment all feature prominently in these models. Time, however, remains largely absent, treated instead as a technical parameter within epidemiology. It appears in calculations of disability-adjusted life years, in critical periods of vulnerability, or as an implicit resource that people need to exercise, eat well, attend appointments, and maintain relationships. But this framing assumes everyone has roughly comparable access to time, an assumption the new paper argues is demonstrably false.

Sociology offers a richer picture. Time is not only measured by clocks and calendars but lived as duration, pace, and anticipation, all shaped by economic relations and the finite span of human life. Critically, perceptions of time are tied to identity and a person’s sense of control over their own existence. When people report lacking time, they are not simply reporting an insufficient number of hours; they are describing how their time is structured, valued, and constrained by forces beyond their individual choosing. Reframing time this way transforms it from a methodological convenience into a structural exposure—one that can be measured, modeled, and, in principle, changed through policy.

The paper identifies two interrelated dimensions through which time operates on health: availability and intensity. Availability refers to the absolute quantity of discretionary time a person commands. Intensity captures the lived experience of rushing, acceleration, and constant pressure. In many market-driven societies, emphases on productivity have accelerated daily rhythms at work and at home, intensified by technological change, urbanization, and flexible labor markets that blur the boundary between employment and the rest of life. The result is what researchers describe as boundaryless work—employment that seeps into evenings, weekends, and mental space—alongside the persistent devaluation of unpaid care.

Within labor markets, temporal pressure is organized through two dimensions of working time: control and variability. Working time control describes how much autonomy employees have over when, where, and how they work, which shapes their capacity to protect time for rest, care, and other non-market activities. Working time variability captures how much hours fluctuate, reflecting the predictability of daily rhythms. Evidence from across Europe shows that higher variability, especially when combined with low control, is associated with worse self-rated health, more psychosomatic complaints, and more frequent sleep problems. Meanwhile, indicators such as discretionary time, subjective time scarcity, time poverty, and time excess appear to mediate the well-documented association between socioeconomic status and health—and the health consequences of time poverty differ sharply between high- and low-income groups.

The burdens are not distributed equally. People working multiple jobs, and those combining paid employment with caregiving, face severe constraints on both the amount and the intensity of their time. Women are overrepresented in these situations and globally spend on average 2.8 more hours per day than men on unpaid care and domestic work. Because women, particularly those with lower incomes, perform the largest share of unpaid domestic and care labor, inequalities in time constitute a key mechanism through which social and gender disparities in health are reproduced. Migration, armed conflict, and economic instability deepen these patterns further, as uncertainty and chronic temporal strain become defining features of everyday life.

The relationship between time and health is also bidirectional, creating cycles that entrench disadvantage. Time constraints limit engagement in health-promoting behaviors such as physical activity or preparing nutritious meals, while fostering fatigue, negative mood, and stress-related physiological responses. Conversely, living with illness or disability reshapes how people can use and control their time, restricting participation in paid work, caregiving, and social life. Research on treatment burden shows that managing chronic illness entails substantial unpaid labor—information seeking, medication management, appointments, self-monitoring, lifestyle changes, financial tasks, and navigating health systems. These burdens are socially patterned too: most treatment burden measures were developed in high-income settings and may fail to reflect the experiences of people with lower health literacy or greater socioeconomic constraints. The result is a self-reinforcing loop in which poor health consumes time, and scarce time worsens health.

Healthcare systems themselves are built on temporal assumptions that often fail patients. Care is organized around clock time, standardized schedules, and linear treatment trajectories that rarely match the lived temporalities of chronic illness, disability, or long-term care. Patients juggling paid work and caregiving, or living with limited material resources, must navigate overlapping temporal scales and trade present time for uncertain future benefits. The misalignment disproportionately harms the socially disadvantaged. One promising response is coordinated care that aligns multiple appointments or services within a single visit, reducing the time costs of fragmented care—a model with demonstrated potential for patients with multimorbidity.

Making time visible in epidemiology has direct methodological consequences. Conventional models that treat time as neutral or exogenous obscure how temporal scarcity, acceleration, and uncertainty function as socially patterned exposures, and may systematically misattribute responsibility to individual behavior in ways that reproduce inequity. Existing infrastructures already make measurement feasible: the Harmonised European Time Use Surveys and the Multinational Time Use Study provide harmonised 24-hour diary data on paid work, unpaid care, personal care including sleep, travel, and leisure, alongside sociodemographic information. Incorporating these temporal dimensions into study design would allow research to better reflect lived experience across social groups and countries.

At the level of primordial prevention, the paper calls for engagement through public health diplomacy—advocating health in all policies beyond the health sector. That includes social protection systems that buffer economic uncertainty, labor policies regulating working hours and job security, housing policies shaping residential stability and commuting time, and transport infrastructure that reduces time poverty. Family-related policies such as paid parental leave, accessible childcare, and elder care support can ease the temporal pressures on working-age adults caring across generations. The ultimate claim is ambitious but straightforward: ensuring that people have the temporal conditions necessary to exercise choice, participate in society, and live healthy lives is not a luxury but a prerequisite for health equity, and reclaiming time as a determinant of health is fundamental to advancing population well-being.

Subject of Research: Time as a socially structured determinant of health and health equity

Article Title: Reclaiming time as a fundamental determinant of health equity

Article References: Reclaiming time as a fundamental determinant of health equity. (n.d.). https://doi.org/10.1016/j.ssmph.2026.101939

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101939

Keywords: health equity, social determinants of health, time poverty, working time, unpaid care work, gender inequality, treatment burden, chronic illness, public health policy, epidemiology, time use surveys, social acceleration