Social Determinants of Health

Social Determinants of Health include the conditions in which people are born, grow, live, work and age, and are the fundamental drivers of these conditions: the distribution of power, money, and resources. The Book The Social Determinants of Health- The Solid Facts by Marmot discusses how public policy can have positive or negative implications on the Social Determinants of Health. Poor Social and economic circumstances affect health not just in the life expectancy of the individual but also across society. Among middle-class office workers, lower-ranking staff suffer much more disease and earlier death than higher-ranking staff. (2003)

The book looks at major life transitions: moving from primary to secondary education, starting work, leaving home and starting a family, changing jobs, and retirement. At each one of these transitions, there is the opportunity to increase your social health by moving up the social gradient, or there is the opportunity for a more disadvantaged path. I reflect on my current decision to further my education by enrolling in graduate studies. Education is an opportunity to move up the social gradient into leadership positions, increase earning potential, personal growth, and obtain specialized skills. For others, the option to pursue secondary education is not available due to social inequalities such as inequality of opportunity, inequality of wealth, and geographic inequality. Lack of opportunity can decrease job satisfaction, which can decrease our health. "Several European workplace studies show that health suffers when people have little opportunity to use their skills and low decision-making authority." (Marmot, 2003)

As adults, we can make decisions that can help us try to combat the social determinants of health. Still, children who may be born into their socio-economic environment will rely on policies and programs to support their parents. Giving every child the best start in life is crucial to reducing health inequalities across the life course. (M.Marmot, 2012) I am thankful in Canada for our 12 or 18-month paid maternity leave. It is the health policy that has created this start for my children. In the first 12 months of their lives, I could stay home and be the children's main provider. Without paid maternity leave, I would have been forced to return to the workforce and rely on a childcare provider to lay the health foundations. "Infant experience is important to later health because of the continued malleability of biological systems. As cognitive, emotional and sensory inputs programme the brain responses, insecure emotional attachment and poor stimulation can lead to reduced readiness for school, low education attainment, and problem behaviour, and the risk of social marginalization in adulthood “ (Marmot, 2003) If I were to live in a country where there was public funded maternity leaves my children would have been at a disadvantage.

It is not solely the responsibility of public health to reduce health inequality. Still, public health does have a critical role. “Public health can contribute to reducing health inequities by integrating health equity considerations into policy and programs, collaborating with other sectors to address inequities, engaging with communities to support their efforts to address inequities, identifying the reduction of health inequities.” (Bernadette (Bernie) Pauly, 2013)

Resources

Wilkinson, R., & Marmot, M. (2003). Social determinants of health - the solid facts. WHO Regional Office for Europe.

Pauly, B.(., MacDonald, M., Hancock, T. et al. Reducing health inequities: the contribution of core public health services in BC. BMC Public Health 13, 550 (2013). https://doi.org/10.1186/1471-2458-13-550

M.Marmot, R. B. (2012). Fair Society, healthy lives. Public Health, S4-S10.