There are challenges to overcome in implementing action to address health inequities through the social determinants of health. The social determinants of health equity is a complex and multifaceted field. It involves a wide range of stakeholders within and beyond the health sector and all levels of government. In addition, social determinants of health data can be difficult to collect and share.
While the evidence base on the social determinants of health has strengthened during the past decade, the evidence base on what works needs to be strengthened and good practices disseminated effectively.
Three areas for critical action identified in the report of the Global Commission on Social Determinants of Health reflect their importance in tackling inequities in health. These include:
Improve daily living conditions:
The circumstances in which people are born, grow, live, work and age;
Tackle the inequitable distribution of power, money and resources:
The structural drivers of those conditions of daily life (for example, macroeconomic and urbanization policies and governance);
Measure and understand the problem and assess the impact of action:
Expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.
Scaled up and systematic action is required that is universal but proportionate to the disadvantage across the social gradient. This is necessary for effective delivery to addressing inequities in health and promoting healthier populations
Social determinants of health
The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are 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. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.
The SDH have an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.
The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways:
- Income and social protection
- Education
- Unemployment and job security
- Working life conditions
- Food insecurity
- Housing, basic amenities and the environment
- Early childhood development
- Social support and inclusion
- Structural conflict
- Access to affordable health services of decent quality.
Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.
Addressing SDH appropriately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil society.
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