Elsevier

Public Health

Volume 126, Supplement 1, 1 September 2012, Pages S4-S10
Public Health

Plenaries
Fair society, healthy lives

https://doi.org/10.1016/j.puhe.2012.05.014Get rights and content

Summary

The final report of the World Health Organization Commission on the Social Determinants of Health (CSDH), published in 2008, affirmed that social injustice was killing on a grand scale, with a toxic combination of ‘poor social policies and programmes, unfair economic arrangements, and bad politics’ being responsible for producing and reinforcing health inequalities. It provided a comprehensive evidence-based discussion of pervasive inequalities of health in many countries, demonstrating the presence of a social gradient in health outcomes associated with the unfair distribution of the social determinants of health. The social determinants of health include the conditions in which people are born, grow, live, work and age, and the fundamental drivers of these conditions: the distribution of power; money; and resources. Following publication of the CSDH report and recommendations for action, the UK Government commissioned a Strategic Review of Health Inequalities in England.

This article provides an overview and reflection on the findings from the CSDH and the Strategic Review of Health Inequalities in England, reviewing the case for putting fairness at the heart of all policy making. In the process, it highlights the need for action on the social determinants of health in order to address health inequalities and the social gradient in health outcomes.

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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