U.N. Commission on Social Determinants of Health  [Printer-friendly version]
February 19, 2006

WHAT ARE THE SOCIAL DETERMINANTS OF HEALTH?

By Michael Marmot

Let's start at the beginning: if you are a fifteen-year-old boy in
Lesotho, your chance of reaching the age of 60 is about 10%. If you
are a fifteen-year-old boy in Sweden, your chance of reaching 60 is
91%. This difference is due to social conditions, which are
determinants of health. They include education and the nature of jobs.
They include living conditions such as housing and availability of
adequate nutritious food. They also entail access to quality health
care.

Similarly, there are big health inequalities within countries. Let's
take the United States, for example. If you catch the metro train in
downtown Washington, D.C., to suburbs in Maryland, life expectancy is
57 years at beginning of the journey. At the end of the journey, it is
77 years. This means that there is 20-year life expectancy in the
nation's capitol, between the poor and predominantly African American
people who live downtown, and the richer and predominantly non-African
American people who live in the suburbs.

Now, a poor man in inner-city Washington, D.C., is rich in material
terms when compared to a poor man in Lesotho. The social determinants
of these two individual's lives are different, and we must acknowledge
this and think of poverty in a different way. It is about
opportunities in life and control over one's life, in addition to
social conditions that shape the physical environment one lives in.

Realistically, can anything be done about the social determinants of
health?

There is much that we can do about the social determinants of health,
having the knowledge and the will. We know, for example, that
unemployment, insecure employment or employment in poor working
conditions harm health. Creating jobs that are secure and improving
conditions of employment will lead to improvements in health. This has
been recognized in some countries. It now needs to be more broadly
applied.

Secondly, we know that where there are concentrations of poverty, with
poor infrastructure, low levels of social cohesion, more than health
suffers. But there are other effects such as high rates of crime. The
benefits of investing in better human habitats are likely not only to
improve health, but also lead to safer and more secure environments
for residents and visitors alike.

Third, education is a route to better chances in life. Those better
chances in life translate into better health. We have the knowledge
and the means to guarantee a good education for all. We have to
exercise the will.

What is an example of an effective intervention?

In some countries in Latin America, people living in poor conditions
have underweight children with slowed growth. Poor families can't
afford for their children to go to school, and those who do go don't
learn well because malnutrition hinders their ability to learn and
develop. This is the crux of a terrible cycle where poverty causes
ill-health and ill-health, in turn, perpetuates poverty.

We are very encouraged by the results of some programmes in Latin
America to break this cycle. In some countries, there are programmes
that give families a small economic subsidy to take children to
nutrition clinics and have them enrolled in school.

Children are malnourished because their parents are poor. With more
money, the children get better nutrition. As the programme is
dependent on the children staying in school, they also get better
education. This is a low cost intervention, and it helps to break the
poverty=ill-health cycle by empowering and improving the health of
children, making a difference in their lives that will last into
adulthood.

Copyright World Health Organization 2006. All rights reserved