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Social determinants of health
- Page updated onMarch 17, 2025
Traditionally, in humanitarian action, one always looks to the health sector to address health problems and disease. However, in the humanitarian system, the health sector in isolation can only try to provide health care to people in need, and this is not enough. Health care is certainly one of the social determinants of health, but it is not the only one. It is possibly not the most important one either.
A large part of health problems are due to the conditions in which people are born, grow, live, work and age. Inequality in these conditions is the result of a toxic combination of poor social policies, unfair economic arrangements and political mismanagement. For this reason, to address the social determinants of health, it is necessary to end the unequal distribution of power and economic resources, from a public sector with strong governance and civil society participation.
Table of contents:
Social determinants of health in global health policy
How and where you live matters
In the past, it was thought that if economic barriers to access to health care were eliminated across all social classes, the health gradient between them would be reduced. In other words, it would prevent rich people from being healthier and having longer life expectancy than poor people.
However, research carried out in the United Kingdom at the end of the 20th century, such as the Black report of 1980, the Whitehall study of 1987 or the Acheson report of 1998 demolished this idea. Moreover, they demonstrated the tremendous influence of social and economic circumstances on people's health.
Michael Marmot, moreover, a few years later, would manage to take scientific evidence out of academic circles and influence public policy by introducing a new term: social determinants of health. Moreover, he led new reports that showed clear evidence of some of them such as socioeconomic status, psychosocial circumstances that cause stress, educational opportunities and development in the first years of life, poverty and social exclusion, working conditions, unemployment, support networks, support networks and support networks, support networks and social cohesion, addictions, diet, and means of transportation (which largely determine exercise, social interactions and pollution).
Health over economic growth
The next big leap came when in 2008 the final report of the WHO Commission on Health and Macroeconomics, also led by Marmot, was published, which brought social determinants to the heart of global health.
This report challenged the economic view of health as a mere instrument for generating wealth, even determining that achieving better population health is an even more important goal than economic growth. Moreover, the cover of the document read "social injustice is killing people on a large scale". Its authors recommended taking immediate steps to improve the conditions in which people lived, address inequity in the distribution of power, money and resources, and better measure the problem to understand it and monitor the impact of actions.
The report, however, came at a time when actors such as the WHO or the World Bank were displacing primary health care from public health policy, replacing it with universal health coverage. This new noble objective, centered on the financing of health services, does not contemplate the importance of social determinants, with which a certain tension is established. The tension can be resolved immediately, however, with political will to understand that universal health coverage is one more social determinant of health.
Social determinants of health today, in the background?
The tension between universal health coverage and social determinants of health continues to exist. More than fifteen years have passed since the moment that seemed to be the turning point for the global approach to the social determinants of health, but although academic and health care interest continues, there has not been the expected change in policies and actions.
In this time economic inequality has increased - wealth is increasingly concentrated in extreme wealth and poverty in extreme poverty-. In addition, there is a resurgence of political sectors advocating tax cuts and curbing wealth redistribution and social protection.
For all these reasons, today, important social determinants of health continue to be inadequately addressed: health is still understood from the limited vision of health care, progress in universal health coverage has stalled, climate crisis and environmental degradation are increasing, and it seems impossible that the sustainable development goals on food security can be achieved. Moreover, the dimensions of conflicts and forced population displacement are increasing more than humanitarian funding, and progress in reducing gender inequality has slowed so much that it is estimated that, at the current rate, it will still take more than a hundred years to achieve it.
Health fundamentals
External links
- WHO, 2024. Operational framework for monitoring the social determinants of health equity.
- Marmot, 2022. Public health and health inequalities: a half century of personal involvement.
- WHO, 2014. Health in all policies: Helsinki statement.
- WHO, 2011. Rio Political Declaration on Social Determinants of Health.
- WHO, 2010. A conceptual framework for action on the social determinants of health.
- WHO EMRO, 2008. Social determinants of health in countries in conflict.
- WHO, 2008. Final report of the commission on social determinants of health.
- Wilkinson, Marmot, 2003. Social determinants of health: the solid facts, 2nd edition.
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