Elsevier

The Lancet

Volume 365, Issue 9464, 19–25 March 2005, Pages 1099-1104
The Lancet

Public Health
Social determinants of health inequalities

https://doi.org/10.1016/S0140-6736(05)71146-6Get rights and content

Summary

The gross inequalities in health that we see within and between countries present a challenge to the world. That there should be a spread of life expectancy of 48 years among countries and 20 years or more within countries is not inevitable. A burgeoning volume of research identifies social factors at the root of much of these inequalities in health. Social determinants are relevant to communicable and non-communicable disease alike. Health status, therefore, should be of concern to policy makers in every sector, not solely those involved in health policy. As a response to this global challenge, WHO is launching a Commission on Social Determinants of Health, which will review the evidence, raise societal debate, and recommend policies with the goal of improving health of the world's most vulnerable people. A major thrust of the Commission is turning public-health knowledge into political action.

Section snippets

Inequalities in health between and within countries: poverty and inequality

A catastrophe on the scale of the Indian Ocean tsunami rightly focuses attention on the susceptibility of poor and vulnerable populations to natural disasters. It is no less important to keep on the agenda the more enduring problem of inequalities in health among countries.

Social determinants: poverty, inequality, and the causes of the causes

In consulting widely in developing the plan for the Commission on Social Determinants of Health, a common question was: “What's new? We know that poverty is bad for health. Does that need a Commission?”

It is not difficult to understand how poverty in the form of material deprivation—dirty water, poor nutrition—allied to lack of quality medical care can account for the tragically foreshortened lives of people in Sierra Leone. Such understanding is insufficient in two important ways. First, it

Action is possible and necessary

A review of policies in European countries identified several that took action on the social determinants of health.30 Although the reason for the policies was not necessarily to improve health they were nevertheless relevant to health: taxation and tax credits, old-age pensions, sickness or rehabilitation benefits, maternity or child benefits, unemployment benefits, housing policies, labour markets, communities, and care facilities.

In Sweden, the new strategy for public health is “to create

Meeting human needs

Two linked themes provide the rationale for the Commission on Social Determinants of Health. First, there is no choice. If the major determinants of health are social, so must be the remedies. Treating existing disease is urgent and will always receive high priority but should not be to the exclusion of taking action on the underlying social determinants of health. Disease control, properly planned and directed, has a good history, but so too does social and economic development in combating

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