Social determinants of health inequalities

Abstract

There are gross inequalities in health between countries. Life expectancy at birth, to take one measure, ranges from 34 years in Sierra Leone to 81·9 years in Japan. 1 Within countries, too, there are large inequalities—a 20-year gap in life expectancy between the most and least advantaged populations in the USA, for example. 2 One welcome response to these health inequalities is to put more effort into the control of major diseases that kill and to improve health systems. 3,4 A second belated response is to deal with poverty. This issue is the thrust of the Millennium Development Goals. 5,6 These goals challenge the world community to tackle poverty in the world's poorest countries. Included in these goals is reduction of child mortality, the health outcome most sensitive to the effects of absolute material deprivation. To reduce inequalities in health across the world there is need for a third major thrust that is complementary to development of health systems and relief of poverty: to take action on the social determinants of health. Such action will include relief of poverty but it will have the broader aim of improving the circumstances in which people live and work. It will, therefore, address not only the major infectious diseases linked with poverty of material conditions but also non-communicable diseases—both physical and mental—and violent deaths that form the major burden of disease and death in every region of the world outside Africa and add substantially to the burden of communicable disease in sub-Saharan Africa. To understand the social determinants of health, how they operate, and how they can be changed to improve health and reduce health inequalities, WHO is setting up an independent Commission on Social Determinants of Health, with the mission to link knowledge with action (panel 1). Public policy—both national and global—should change to take into account the evidence on social determinants of health and interventions and policies that will address them. This introduction to the Commission's task lays out the problems of inequalities in health that the Commission will address and the approach that it will take. This report will argue that health status should be of concern to all policy makers, not merely those within the health sector. If health of a population suffers it is an indicator that the set of social arrangements needs to change. Simply, the Commission will seek to have public policy based on a vision of the world where people matter and social justice is paramount.