Social determinants of health

Social determinants of health

• By Padma Shri Awardee Dr Marthanda Pillai, Honorary National President Indian Medical Association and Dr KK Aggarwal, President HCFI & Honorary Secretary General Indian Medical Association

There are a series of factors that determine our health; access to social and economic facilities being the most prominent of all. For instance, factors like the conditions in which people are born and the conditions in which they live, work and grow old can impact an individual’s health to a greater extent. These factors directly influence the quality and length of life along with impacting the possibilities of disability-free life.

In most of the cases, medical professionals only evaluate the proximate causes of diseases like smoking, obesity, disrupted lifestyle and alcohol. But the real “causes of causes” are often ignored, which make up for the root of all the medical ills prevailing in the society. However, the effective social determinants approach goes beyond just focusing on proximate causes and seeks to address what actually aggravates premature ill health and the contributing factors.

For instance, the lower people are in the socioeconomic hierarchy, the more they smoke, the more incomplete their diet, and the less physical activity they engage in. Education dominates all the other factors like excessive alcohol consumption, taxation, price and availability, bans on advertising, smoking in public places and tobacco consumption.  

Examples of social determinants include:

• Accessibility and availability of resources to fulfill daily requirements like shelter, food, cloth and much more
• Access to educational institutions, medical establishments, economic opportunities like a job or any other source of earnings
• Access to quality medical facilities and healthcare services
• Quality education, learning and knowledge
• Availability of community-based resources like recreational and leisure-time activities
• Daily-life facilities like transportation and public safety options
• Society’s attitude towards a person; it includes discrimination, racism or any other kind of bias
• Prevailing conditions like crime, violence, lack of cooperation in a community and social disorder
• Socioeconomic conditions like concentrated poverty and other stressful conditions
• Literacy and culture
• Access to mass media and emerging technologies like cell phones, the Internet, and social media

The world is witnessing a universal movement that seeks to address gross inequalities in health and length of life through action on the social determinants of health. This movement has involved the World Health Organisation, several national governments, civil society organization, and academics. Solutions are being sought and learnings shared.

WMA insists that doctors should be well-informed participants in this debate. The medical professionals can be advocates for action on those social conditions that have important effects on health. In addition to this, WMA has agreed to add significant value to the necessary actions being taken:

• By helping doctors, other health professionals and National Medical Associations understand what the emerging evidence shows and what works, in different circumstances
• By helping doctors to lobby more effectively within their countries and across international borders, and ensure that medical knowledge and skills are shared
• Gathering data of examples that are working, and help to engage doctors and other health professionals in trying new and innovative solutions
• Educating and inform their members and put pressure on national governments to take the appropriate steps to try to minimise these root causes of premature ill health
• Drawing up new action plans of action, which include general practice that works across sectors to improve the quality of people's lives and hence reduce health inequalities
• Gathering examples of good practice from its members and promoting further work in this area.