PlenariesFair society, healthy lives
Introduction
The World Health Organization Commission on the Social Determinants of Health (CDSH) provided a robust summary of the gross inequalities in health that can be seen between and within countries.1 The Strategic Review of Health Inequalities in England applied the learning from the CSDH, and identified areas where progress can be made.2 Together, the reports demonstrate a social gradient in health outcomes associated with levels of socio-economic conditions. Statistics showing the enduring problems of health inequalities within and between countries make a stark case for action.
This article argues that public policy needs to consider the evidence of the impact of the social determinants on health, mobilizing action across the whole of government and the whole of society, to address the social gradient in health outcomes. It highlights the need to strengthen the role of ill-health prevention, focussing not just on primary prevention measures but on putting prevention in the context of the social determinants of health.
Section snippets
Inequalities in health: England
Health inequalities show a marked social gradient, with higher levels of disadvantage being associated with worse health outcomes. In England, between 1999 and 2003, both life expectancy and disability-free life expectancy show worse health outcomes for people living in the most-deprived areas. The gap between the most- and least-deprived areas shows a marked gradient, with outcomes worsening according to increasing neighbourhood income deprivation (Fig. 1).
No country is immune. Wherever there
Conclusion
By focussing on the need for action across the gradient in health inequity, which runs from top to bottom of the socio-economic spectrum, a new range of policy options is revealed. When, as is often the case, the policy focus is on health at the bottom of the social gradient, this results in reducing the focus on the gradient as a whole. Applying the evidence systematically, linking knowledge to action, can open up new opportunities for prevention.
There is increasing recognition that
Acknowledgements
This article is based on a lecture given by Sir Michael Marmot at the Public Health International Conference Sept 2011.
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