Social Determinants for the Improvement of Health Status

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• Social and economic conditions are often more important for the status of health than actual healthcare
• WHO wants to eliminate inequalities in the area of healthcare within a generation

In most parts of the world the key to improving people’s health is not in the area of healthcare, but in economic and social policy. This is the most important conclusion of the WHO Commission on Social Determinants of Health in a report it recently presented. Based on several thousand individual studies, Commission Chairman Prof. Sir Michael Marmot discussed the report issued with leading European health experts at the European Health Forum Gastein (EHFG).

“Medical care can lead to an improved course of disease and a higher life expectancy, but it is primarily the social and economic conditions which make people sick in the first place,” Marmot says. “For this reason improvements in these areas are disproportionately more important for the health of the overall population. This fact must be reflected in health policy.”

This is not only true of developing countries, Marmot points out. In rich industrialised nations, as well, social differences are the main reason for inequalities in the health status of the population. “We aren’t talking about a third world issue here, but a problem we can see at our doorstep on a day-to-day basis – if we want to see it,” Marmot says. This is not just a matter of material poverty, but of other social factors such as social isolation, unemployment, the lack of self-esteem and family relations.

The fact that these environmental conditions cannot be changed in the short term is reflected in the title of the report presented recently by the World Health Organisation (WHO). To the WHO and its member states “Closing the Gap in a Generation” recommends a multidisciplinary approach in which health targets are incorporated into every area of policy including education, environmental policy, equal opportunity issues and budget policy. “We have to face these social inequality-related problems, even if there will not be any simple or rapid solutions,” Marmot says. “But only a fair world can be a healthy world.”

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