Social Determinants of Health

Social Determinants of Health have been defined by the World Health Organisation (WHO) as “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness”. A report published by the WHO Regional Office for Europe titled “Social Determinants of Health: The Solid Facts” (edited by Michael Marmot and Richard Wilkinson), explores ten key determinants and their interaction with health outcomes, namely

1. the social gradient as a correlation between groups’ and individuals’ relative position on the social ladder and the frequency of adverse health outcomes.

2. early life, with slow growth and low emotional support during early childhood as key factors contributing to poorer health later in life,

3. stress, with the psycho-social risks of continuing anxiety, insecurity, low self esteem, and lack of control over one’s public and private life negatively impacting individual and collective health outcomes,

4. social exclusion as a source of stress and an obstacle for access to public services and social support,

5. working conditions, as source of stress and a direct cause of ill health in the absence of adequate workplace health protection measures,

6. unemployment as another source of stress and a key factor that negatively impacts an individual’s place on the social ladder

7. social support, in regard to both the emotional and practical support characterizing good social relations,

8. addiction, with alcohol dependence, illicit drug use and tobacco consumption all pointing towards underlying social and economic marginalization

9. healthy food, with both over- and under-nutrition contributing to the  overall burden of disease,

10. transport, in regard to the adverse effects of increasing road traffic (accidents, pollution, stress, decreased physical activity, social isolation) and the benefits of reliable public transportation systems and environments encouraging physical activity (walking and cycling) and stimulating social interaction.

The WHO Commission on Social Determinants of Health (CSDH), set up in 2005, identified the achievement of health equity as the overarching goal in addressing the social determinants of health. Its final report ‘Closing the Gap in a Generation’ (2008) put forward three key recommendations, namely to “(1) to improve daily living conditions, (2) to address the inequitable distribution of power, money and resources and (3) to measure and understand the problem and assess the impact of action”. It emphasized the intersectoral nature of both health problems and solutions and called for a new inclusive approach where “health and health equity may not be the aim of all social policies but they will be a fundamental result”. The social determinants of health approach is thus closely tied to ‘Health in All Policies’ strategies.

In May 2009, the 62nd World Health Assembly endorsed the CSDH report and requested WHO to “convene a global event to discuss renewed plans for addressing the alarming trends of health inequities through addressing social determinants of health”. As a result, the 2011 Rio World Conference on the Social Determinants of Health was convened in October 2011 and adopted the Rio Political Declaration on Social Determinants of Health. The declaration expressed political support for priority action on the social determinants of health, affirming the right to the enjoyment of the highest attainable standard of health and stressing the importance of intersectoral mechanisms such as the Health in All Policies approach.