Why are the poor sicker? Also, why do inequalities in health still exist even within the wealthiest countries like the U.S.? What both of these questions have in common is the issue of the social determinants of health. When it comes to understanding what the social determinants of health are, I find one of the most useful readings to be Social Determinants of Health: The Solid Facts 2nd Edition which was published by the World Health Organization (WHO).1
Within this document, social determinants of health are divided into ten components.2 While the policy suggestions are very well tailored for each of the factors, I cannot help it but to think of the barriers that exist if we are to implement and financially sustain these policies to reduce health inequalities in the U.S., especially in the current economy where even the mention of health care reform divides the government.
A couple of examples of the proposed policies:
– “Interventions to reduce poverty and social exclusion are needed at both the individual and the neighborhood levels.”
Implementing this policy would be extremely costly and difficult. How would such interventions be conducted? What kind of incentives can the government provide for the local neighborhoods to do this?
– “Ensure that parent-child relations are supported from birth, ideally through home visiting…to stimulate cognitive development and pro-social behavior in the child, and to prevent child abuse.”
How would this be implemented? How will it be financed? How can we ensure the accountability of the social workers and the parents? How would you monitor this program?
The U.S. still has a relatively long way to go to reduce the inequalities of health within its population. Welfare programs, unemployment benefits, minimum wage policies have all been set up and implemented in the States but its impact in reducing health disparities is still limited. However, issues such as social exclusion, quality education and equal access to health care still need to be addressed. If such issues are to be addressed and policies are to be created to reduce inequalities of health in the U.S., policy makers will really need to think of a way to execute, monitor and sustain such programs.
- This document is a condensed version of a book on Social Determinants of Health edited by Michael Marmot and Richard G. Wilkinson.
- The ten components are: social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food and transport.