Social Determinants

Health inequity between people in the same country and between countries are an urgent issue of social justice. These health inequities are the result of non-medical factors linked to the environment in which people are born, grow up, live, work, age and die, all of which have a direct incidence on individual health. These factors are themselves determined by the wider social, political, cultural, environmental and economic context.

The World Medical Association (WMA) adopted the Declaration of Oslo, recognising the importance of the social determinants of health. Among other things, the Declaration  emphasize that physicians, as trusted leaders of their communities, are well positioned to advocate on behalf of individuals, communities and the healthcare workforce, and put pressure on governments to adopt policies and actions to reduce health inequities and improve the conditions in which people live.

Health Inequalities

While life expectancy in general and healthy life expectancy in particular, have increased overall, these improvements vary between demographic groups, with a persistent and growing disparity.

Poor populations are invariably in poorer health than rich populations. For example:

• There is a difference of 18 years of life expectancy between high- and low- income countries;
• In 2016, the majority of the 15 million premature deaths due to non-communicable diseases (NCDs) occurred in low- and middle-income countries;
• The disparities within a country between the poorest and richest populations for diseases such as cancer, have increased in all regions of the world;
• The mortality rate for children under the age of 5 is more than eight times higher in Africa than in Europe. Within a single country, improvements in child health have been hampered by slower progress for the poorest populations.

Many of these health disparities are the result of structural barriers linked to decision-making processes, policies and social norms at all levels of society.

Addressing Social Determinants of Health

The World Health Organization has released an operational framework for monitoring social determinants of health equity which includes actions to address the health gap. This guidance is designed to help countries develop evidence-based policies to improve equity in health, with the aim of enabling everyone, everywhere, to attain the highest possible standard of health and well-being.