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Social Determinants of Health

November 8, 2013

WHO Report3Last week in London there was a symposium on the publication of the document, Review of Social Determinants and the Health Divide in the WHO European Region: Final Report. WHO/Europe commissioned the review to support Health 2020, the European policy framework for health and well-being.

The 3-year review compiled evidence on the 53 countries in the WHO European Region, and describes social-policy actions that governments can take in 12 priority areas, from early-childhood education to employment and the provision of social protection according to need.

By coincidence, there is a connection between the AJPM and the London symposium. Key speakers included Professor Sir Michael Marmot, Director of the University College London Institute of Health Equity, who you might recall contributed to the AJPM 2011 supplement, Strong Medicine for a Healthier America, which focused on the social determinants of health.

It would be hard to exaggerate the importance of this topic. For example, tackling social determinants of health is a fundamental approach to the work of the WHO and a priority area in its general program of work 2014–2019.

As you know, the social determinants of health are the conditions in which people are born, grow, live, work, and age. These conditions of daily life are, in turn, influenced by structural drivers, the economic arrangements, power structures, gender equity, policy frameworks, and the values of society. Thus, health is shaped by the distribution of money, power, and resources at global, national, and local levels.

Professor Marmot’s commentary in the AJPM supplement compared European reports on health inequities with the RWJF commission report, Overcoming Obstacles to Health. His concluding remarks contained the following challenge:

It [The RWJF commission] has taken a potentially transformational first step. It is now of great importance to move to the further steps that are needed…consistent with its analysis. The good health of all Americans, the stated goal, requires it.

The London symposium reviewed some of the steps taken in Europe since Professor Marmot issued his challenge in 2011. The 3-year review (which he chaired) responded to demands from policymakers for practical guidance on social policies that work to reduce inequities in health.

The report underlines the “stubborn and tenacious nature” of health inequalities across Europe, finding that the predominant tendency at present is for health inequities within and between countries to widen. (This trend is not confined to Europe.) Acknowledging the complex and long-term causal pathways for an individual’s health, the report also sees the debate between personal responsibility on the one hand and social action on the other to be poorly focused.

Nevertheless, the review contains what it describes as unprecedented economic and human-rights-based evidence on why and how to address social determinants of health. And prominent in the report is the contention that the right to health is a moral claim on the capability to be healthy, which along with other human rights such as freedom from poverty, gender equality, housing, food, and education, provides a framework for addressing the broad range of social determinants of health and health inequities.

The review calls for the highest priority to be given to ensure a good start in life for every child. Specific action should provide conditions for good quality parenting and family-building, and ensure universal early years education and care. I will be writing on this subject, especially in the context of the seminal Adverse Childhood Experiences (ACE) study, in subsequent blogs.

— Michael Lytton, AJPM Blog Editor

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