Social Determinants of Health and Lifestyle Medicine in Viet Nam: Why Healthy Choices Are Not Just Personal Choices

Social Determinants of Health and Lifestyle Medicine in Viet Nam: Why Healthy Choices Are Not Just Personal Choices

Last reviewed: September 2026

Lifestyle Medicine places considerable attention on behaviors that influence health: what we eat, how physically active we are, how well we sleep, how we respond to stress, whether we use tobacco or other harmful substances, and the strength of our social connections. This focus is important because everyday behaviors can have a substantial influence on the prevention and management of chronic disease.

But healthy choices do not happen in a vacuum. A recommendation to “eat healthier” means something very different to a person who has sufficient income, ready access to appropriate food and time to prepare meals than it does to someone working long hours on a limited budget. Advice to “exercise more” may be relatively straightforward for someone with flexible time and access to safe places for physical activity, but much harder for a shift worker, a caregiver or someone living in an environment where regular activity is difficult.

Lifestyle Medicine therefore needs to ask not only what people do, but also what makes those behaviors easier, harder or sometimes unrealistic. People still make choices, but the range of realistic choices is not the same for everyone.

This is where the social determinants of health become important.

What are the social determinants of health?

The World Health Organization defines the social determinants of health broadly as the conditions in which people are born, grow, live, work and age, together with their access to power, money and resources. These conditions include factors such as education, employment, income, housing, working conditions, social protection and access to opportunities and services. They contribute to unfair and avoidable differences in health within and between populations.

Health is therefore shaped by more than biology, healthcare and personal behavior. Social and environmental conditions can influence exposure to risk, access to protection and treatment, the resources available to maintain health, and the opportunities people have to adopt healthier behaviors. The World Health Organization's 2025 World Report on Social Determinants of Health Equity emphasizes that these conditions exert a powerful influence on avoidable and unjust health gaps.

For Lifestyle Medicine, the practical implication is straightforward: behaviors commonly described as “lifestyle choices” are partly shaped by the conditions in which people live. Recognizing this does not mean that personal behavior no longer matters. It means that a clinically useful approach to behavior change needs to understand the context in which that behavior occurs.

Why social determinants matter to Lifestyle Medicine

The relationship between social conditions and Lifestyle Medicine is now explicitly reflected in the field's competency framework.

The 2025 Lifestyle Medicine Core Competencies added a new competency requiring healthcare professionals to apply Lifestyle Medicine interventions in the context of social determinants of health to improve health outcomes and health equity. The update highlights assessment of patients' social and economic environments, culturally relevant interventions and effective collaboration with interdisciplinary teams and communities. It also recognizes that social, cultural and structural conditions can affect whether an intervention is realistic and sustainable.

This is an important development. Without attention to context, Lifestyle Medicine can become too individualistic. If poor health is explained only in terms of food, activity, sleep or personal habits, clinicians may overlook why those behaviors developed and what makes them difficult to change.

A more useful question is therefore not simply, “Why isn't this patient following the recommendation?” It is also, “What is making this recommendation difficult to follow, and what can realistically be changed?”

That shift does not weaken Lifestyle Medicine. It makes it more clinically relevant.

Healthy eating is influenced by more than nutrition knowledge

Nutrition provides one of the clearest examples. Two people may receive the same recommendation to consume more minimally processed foods, vegetables, fruit, whole grains or other nutritious foods, but their ability to act on that recommendation may differ considerably. Food prices, household income, cooking facilities, work schedules, family preferences, cultural practices and the food available near home or work all influence what eventually appears on the plate.

A person may understand perfectly well what a healthier meal looks like and still find it difficult to prepare one regularly. Repeating nutrition information is unlikely to solve a problem caused mainly by affordability, time or availability. A more useful clinical conversation might explore which healthier foods are already familiar and affordable, which meals create the greatest difficulty, whether food preparation can be simplified and which changes are most likely to produce meaningful benefit without creating an unrealistic financial or practical burden.

The food environment in Viet Nam is also changing. In September 2026, World Health Organization Viet Nam noted increasing consumption of ultra-processed foods, fast foods and sugar-sweetened beverages, alongside the country's growing burden of noncommunicable diseases. At the same time, Vietnamese cuisine continues to offer many traditional foods and dietary practices that can support healthier eating.

This is one reason culturally relevant nutrition matters. Lifestyle Medicine should not require patients in Viet Nam to abandon Vietnamese food culture or adopt an imported “Lifestyle Medicine diet.” The aim is to apply evidence within the patient's actual food environment, medical condition, culture and resources.

The 2025 Core Competencies also updated the nutrition competency relating to food processing, asking professionals to appraise how the level and type of food processing affect health outcomes. This encourages a more nuanced approach than simply dividing foods into “good” and “bad.”

Physical activity depends partly on the environment around us

“Exercise more” can sound simpler than it is. Physical activity is influenced not only by motivation but also by working hours, transport, physical limitations, neighborhood design, access to public spaces, traffic safety, weather, caregiving responsibilities and the nature of a person's work.

A desk-based employee with a long commute faces different barriers from a manual worker who is already physically fatigued by the end of the day. An older adult worried about falls needs a different plan from a healthy young adult. A person without access to a gym may still be able to increase activity through walking, stair use, home-based exercise or other forms of movement.

Recognizing these differences does not mean lowering the standard of care. It means designing an intervention that has a greater chance of being implemented.

At the policy level, Resolution No. 72-NQ/TW of September 2025 identifies healthier living, working and learning environments, physical activity, public sports facilities and public spaces among areas relevant to improving population health. It also refers to nutrition appropriate to the health status, culture and economic circumstances of people in Viet Nam. These are policy directions rather than individual clinical prescriptions, but they illustrate the broader connection between health behavior and the environment in which it takes place.

A clinician cannot redesign a neighborhood during a consultation. The clinician can, however, avoid recommending a physical activity plan that assumes every patient has the same time, safety, mobility or access to facilities.

Sleep is also shaped by work and family life

Sleep is sometimes discussed as though people simply need to make a better decision about bedtime. In reality, sleep may be constrained by night shifts, rotating schedules, multiple jobs, long commuting times, childcare, caregiving, crowded living conditions, environmental noise, psychological distress or medical disorders.

For a person working rotating shifts, maintaining an identical sleep schedule every day may not be realistic. For a parent caring for a young child or someone caring for an older family member, insufficient sleep may not primarily reflect poor sleep habits.

Lifestyle Medicine should still assess sleep and help the patient identify opportunities for improvement, but the reason for poor sleep affects what a sensible intervention looks like. One patient may benefit from modifying evening routines. Another may need assessment for obstructive sleep apnea or chronic insomnia. Someone else may need to negotiate practical support from family members or protect sleep during changing work schedules.

The goal is not to lower expectations. It is to avoid treating every barrier as a failure of discipline.

Stress cannot always be managed by asking people to relax

Breathing exercises, physical activity, mindfulness, psychological interventions and social support can all play useful roles in managing stress. But they do not remove unemployment, financial insecurity, unsafe working conditions, family violence, caregiving burden or unstable housing.

A clinician does not need to solve every social problem affecting a patient's life. That is neither realistic nor the purpose of clinical Lifestyle Medicine. The clinical task is to recognize when these circumstances are affecting health and avoid reducing every form of distress to an individual's inability to “manage stress.”

Where appropriate, the response may include psychological care, social support, workplace resources, community services or referral to another professional or organization. Sometimes the most useful clinical adjustment is simply to design a care plan that does not add an unreasonable burden to a person who is already managing significant pressures.

This is different from explaining that stress is harmful and then adding another demanding task to the patient's list.

Social connection shows how lifestyle and social context overlap

Positive social connection is one of the six commonly recognized pillars of Lifestyle Medicine. It also illustrates how individual behavior and social circumstances are often difficult to separate.

People do not create their social worlds entirely on their own. Family structure, migration, work, neighborhood, age, disability, caregiving responsibilities, cultural expectations and access to community life all influence opportunities for connection.

An older adult living alone may experience social isolation differently from a university student who has moved away from family or a worker living far from their usual support network. The appropriate response will therefore vary. For some people, deliberately reconnecting with family or friends may be helpful. For others, peer groups, community activities, volunteering, social services, cultural or faith communities, or other locally available resources may be more relevant.

The point is not to “prescribe friendship.” It is to recognize that relationships and social environments influence physical and mental health, and that meaningful social connection cannot always be reduced to an individual lifestyle instruction.

Access to healthcare is also part of the picture

Healthy behavior does not remove the need for healthcare. A person can eat well, remain physically active, avoid tobacco and maintain strong relationships and still need vaccination, screening, diagnosis, medication, mental healthcare, surgery or specialist treatment.

Access to these services is influenced by geography, income, transportation, health literacy, disability and the organization of the health system itself.

This is particularly relevant in Viet Nam as the country strengthens primary healthcare and expands community-based management of chronic disease. In September 2026, the World Health Organization reported that an expanded hypertension-control model at the grassroots level was screening approximately 10 million people each year and treating more than 2 million, with the aim of improving equitable access and continuity of care closer to where people live. The same report noted that hypertension and other noncommunicable diseases contribute to around 80% of deaths in Viet Nam.

Lifestyle Medicine should therefore complement stronger primary care, prevention and access to effective medical treatment. It should not become a substitute for them.

Health equity does not mean giving every patient exactly the same support

Health equity is concerned with reducing unfair and avoidable differences in health and in people's opportunities to achieve good health. This does not necessarily mean that every patient receives an identical intervention.

In clinical practice, the distinction can be very practical. One person may need only brief advice and a written plan, while another may need repeated follow-up. A patient who is comfortable with digital technology may benefit from a remote monitoring tool, while another person may require face-to-face explanation or involvement of a family member. One household may be able to purchase particular recommended foods, while another needs a plan based around affordable foods that are already available locally.

Different levels or forms of support do not automatically represent different standards of care. In some circumstances, adapting support to need is necessary if the underlying clinical recommendation is to have a realistic chance of working.

The World Health Organization's 2025 report also emphasizes that health inequities cannot be addressed by healthcare alone. Education, employment, housing, social protection and other sectors can all influence health, which is why action on social determinants extends beyond the health system.

Recognizing social determinants does not remove personal agency

There is an important balance to maintain. If health professionals focus only on personal responsibility, they risk blaming patients for circumstances they do not fully control. But if every behavior is explained entirely by social conditions, there is a different risk: underestimating people's ability to make meaningful changes within the circumstances they face.

Lifestyle Medicine can recognize both agency and constraint.

A patient with limited financial resources may still be able to improve dietary patterns. A shift worker may still find ways to protect sleep. Someone living in a crowded urban environment may still become more physically active. But the intervention is more likely to succeed when it starts from the patient's real life rather than from an idealized version of healthy living.

The clinically useful question is therefore not only, “What should this person do?” It is also, “What can this person reasonably do in their current circumstances, and what support would make the healthier option more achievable?”

This approach respects the patient's ability to make decisions without pretending that everyone is making those decisions from the same starting point.

What can clinicians actually do about social determinants?

Clinicians cannot solve poverty, housing, transport, employment or other structural problems during a medical consultation, and Lifestyle Medicine should not imply that they can. What clinicians can do is recognize when those conditions are affecting a clinical problem and incorporate that information into care.

That may involve asking respectfully about barriers rather than making assumptions, identifying which changes are realistic, prioritizing interventions with the greatest likely benefit and avoiding unnecessarily expensive or inaccessible recommendations when simpler evidence-based alternatives are available.

Where appropriate resources exist, clinicians may also work with other healthcare professionals and community services. Depending on the patient's needs, this might involve clinical nutrition, psychology, nursing, rehabilitation, social services, community-based programs or other forms of support.

The 2025 Lifestyle Medicine competency update specifically emphasizes culturally relevant interventions and collaboration with interdisciplinary teams and communities. It does not suggest that clinicians should personally provide every service a patient may need.

This distinction is particularly important in Viet Nam. Identifying a social need does not give a professional authority to perform activities outside their professional competence or authorized scope. Where an activity constitutes medical examination or treatment, the requirements of the Law on Medical Examination and Treatment continue to apply to practitioners and healthcare facilities. The current consolidated version of that law is Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026.

Understanding context can improve clinical care. It does not erase professional boundaries.

Healthcare organizations can also make healthy choices easier

Some barriers cannot be addressed effectively one patient at a time. Healthcare organizations can examine whether their own services make care and healthy behavior easier or harder to access.

Appointment schedules, communication methods, health literacy, affordability, accessibility for people with disabilities, continuity of care, multidisciplinary services and the design of patient education all influence whether a clinical recommendation can be implemented in everyday life.

Group care, remote follow-up and digital tools may improve access for some patients, but they may create new barriers for people with limited digital access, low digital confidence or other disadvantages. New models of care should therefore be evaluated not only according to whether they work on average, but also according to who can use them and who may be left behind.

The same principle extends beyond healthcare. Schools, workplaces, communities, food systems, transport, housing and urban planning can shape the conditions in which health behaviors occur. The World Health Organization therefore describes action on social determinants as requiring participation across government, healthcare, civil society and the private sector rather than action by healthcare professionals alone.

Lifestyle Medicine has a place in this broader conversation, but good clinical practice also requires honesty about what healthcare can and cannot accomplish.

The legal and policy environment in Viet Nam is placing greater emphasis on prevention

Viet Nam's health policy and legal environment has changed significantly.

The Law on Disease Prevention No. 114/2025/QH15, adopted on December 10, 2025 and effective from July 1, 2026, establishes a national legal framework for disease prevention. It covers communicable and noncommunicable diseases, mental disorders and nutrition in disease prevention, and includes communication aimed at supporting changes in behavior and lifestyle for disease prevention.

This does not create a separate legal status for Lifestyle Medicine, and it does not make every social determinant the responsibility of a healthcare professional. It does, however, place prevention, noncommunicable disease risk and healthier behavior clearly within the country's current legal framework for disease prevention.

At the policy level, Resolution No. 72-NQ/TW of September 2025 also emphasizes prevention, primary healthcare, healthy living environments, physical activity, nutrition, mental health and improved access to healthcare. These policy directions should be distinguished from the requirements of legislation, but they provide useful context for understanding the direction in which prevention and community-based health services are developing in Viet Nam.

Recent implementation is already visible. The World Health Organization's September 2026 report on grassroots hypertension and diabetes care illustrates how prevention, early detection and chronic disease management are increasingly being brought closer to communities rather than being concentrated only at higher-level hospitals.

For Lifestyle Medicine, this creates an opportunity to contribute, but also a responsibility to avoid oversimplification.

Lifestyle Medicine should not become lifestyle blame

Perhaps the most important clinical lesson from the social determinants of health is that behavior should not automatically be treated as a moral judgment.

Obesity does not prove that someone lacks discipline. Poor sleep does not necessarily mean someone has ignored sleep advice. Physical inactivity may reflect much more than motivation. Difficulty following a dietary recommendation does not automatically mean that a patient does not care about their health.

A stronger Lifestyle Medicine approach is curious rather than judgmental. It asks what is happening, what matters to the patient, what is getting in the way and what change is realistic now.

This does not mean avoiding difficult conversations about behavior or removing personal responsibility. It means focusing responsibility where it can actually produce change. Patient and clinician can work together on factors that are modifiable while recognizing barriers that may require different forms of support or broader action.

Stigma is not a treatment strategy.

Healthy choices matter, but so do the conditions that make them possible

Lifestyle Medicine has an important message: daily behaviors can have a profound influence on health. That remains true, but the development of the field also requires an equally important recognition: people do not have equal opportunities to live those behaviors.

Income can influence food options. Work can influence sleep and physical activity. Education can influence health literacy. Housing and neighborhoods can influence stress, safety and opportunities for movement. Social relationships can support or undermine behavior change. Access to healthcare can determine whether disease risk is identified before complications develop.

Good Lifestyle Medicine therefore does more than explain what a healthy lifestyle looks like. It tries to understand the conditions in which healthier behavior has to occur.

For clinicians, that means making recommendations that are evidence-based, culturally relevant, realistic and appropriate to the patient's circumstances. For healthcare organizations, it means designing services that do not unintentionally widen existing gaps. For communities and policymakers, it means recognizing that healthier populations depend partly on environments that make healthier living more achievable.

The goal is not to replace personal responsibility with social responsibility. It is to understand that better health often depends on both individual action and the conditions that make that action possible.

That is an important part of making Lifestyle Medicine not only evidence-based, but also clinically realistic and equitable in Viet Nam.

References

1. World Health Organization. World Report on Social Determinants of Health Equity. Geneva: World Health Organization; 2025.

2. World Health Organization. Social Determinants of Health. Fact sheet. May 6, 2025.

3. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. doi:10.1177/15598276251379821.

4. Krishnaswami J, Sardana J, Daxini A. Community-Engaged Lifestyle Medicine as a Framework for Health Equity: Principles for Lifestyle Medicine in Low-Resource Settings. American Journal of Lifestyle Medicine. 2019;13(5):443–450. doi:10.1177/1559827619838469.

5. World Health Organization Viet Nam. Strengthened grassroots health care brings NCD services to 10 million in Viet Nam. September 8, 2026.

6. World Health Organization Viet Nam. Speech of Dr Angela Pratt at KOL Workshop on Nutrition and NCDs. September 15, 2026.

7. National Assembly of Viet Nam. Law on Disease Prevention No. 114/2025/QH15, dated December 10, 2025, effective July 1, 2026.

8. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH, Law on Medical Examination and Treatment, dated February 26, 2026.

9. Politburo of the Communist Party of Viet Nam. Resolution No. 72-NQ/TW on breakthrough solutions to strengthen the protection, care and improvement of people's health, dated September 9, 2025.

This article is intended for professional education and general information. It does not provide individualized medical or legal advice. Clinical decisions should take account of the patient's circumstances, current evidence, applicable professional scope and the laws and regulations in force at the relevant time.

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