Where a person is born, and the socioeconomic conditions in which they are born to, end up playing a major role in their life – even determining their life expectancy and the quality of their health.
As explained by the World Health Organization (WHO), the social determinants of health, which include safe housing, public safety, access to educational and employment opportunities, access to health care, food security, among others, are non-medical indicators that will play a major role in an individual’s mental and physical health.
Furthermore, the WHO explains that factors like the inequal distribution of money, power and resources at global, national and local levels directly impact communities in their entirety. Hundreds of thousands of deaths are still tied to these inequalities: a study that measured adult deaths related to social factors showed that, 19 years ago, in the United States, around 245,000 deaths were tied to low education, 176,000 to racial segregation, and 119,000 were due to income inequality.
How are governments tackling these issues? In the United States, moving from fee-based to an outcome-based approach in healthcare has been key to address the social determinants of health and shifting towards social, economic, and health equity. The enactment of the Affordable Care Act in 2010 –which, in general, pretends to lower healthcare costs for households with incomes under the federal poverty level – has been a paramount step to reduce the healthcare access gap in communities across the country.
Around the world, leaders have been working on healthcare initiatives taking the impact of social determinants of health as a starting point. England, for example, integrated the recommendations of the Commision of the Social Determinants of Health (CSDH) into their Fair Society, Healthy Lives review. Here, they adapted the following: (a) give every child the best start in life, (b) improve education and life-long learning, (c) create fair employment and jobs, (d) ensure a minimum income for a healthy standard of living, (e) build healthy and sustainable communities, and (f) apply a social determinants’ approach to prevention.
Actions rooted in social and economic changes have influenced policies in countries like Argentina, Chile, Costa Rica, Sri Lanka and Australia. The latter, as described in their website, promotes “healthy public policy, based on the understanding that health is not merely the product of health care activities, but is influenced by a wide range of social, economic, political, cultural and environmental determinants of health” in their Health in All Policies approach. They call for “joined-up policy responses” to recognize multisectoral responsibility.
As proof of the effects of social determinants of health become more visible around the world, an undeniable truth comes to light: there is an urgent need for a broader, more comprehensive take on actions to eradicate systematic inequalities and improve population health. This will help reduce the gap within disadvantaged communities and create better health outcomes for generations to come.
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