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Michael Marmot - One of the best experts on this subject based on the ideXlab platform.

  • social Determinants of Health equity
    American Journal of Public Health, 2014
    Co-Authors: Michael Marmot, Jessica Allen
    Abstract:

    Language is important. The call for papers in this supplement was entitled Health equity. Yet the call asked for papers that address disparities in Health. In the United States, disparities, most often, has been used to refer to racial/ethnic differences in Health, or more commonly Health care. We note that the call in this supplement expands the focus and highlights differences by socioeconomic status and geographic location, among others. By tradition, in the United Kingdom we have used the term inequalities to describe the differences in Health between groups defined on the basis of socioeconomic conditions. To reduce Health inequalities requires action to reduce socioeconomic and other inequalities. There are other factors that influence Health, but these are outweighed by the overwhelming impact of social and economic factors—the material, social, political, and cultural conditions that shape our lives and our behaviors. Much of the evidence describing this was set out in the World Health Organization Global Commission on the Social Determinants of Health.1 In fact, so close is the link between social conditions and Health, that the magnitude of Health inequalities is an indicator of the impact of social and economic inequalities on people’s lives. Health then becomes an important further cause for concern about the rapid increase in inequalities of wealth and income in our societies. Increasingly, we are using the language of Health inequity to describe those Health inequalities that, though avoidable, are not avoided and hence are unfair. Two particular issues stand in the way before we can act on knowledge of social Determinants of Health to address Health equities: lifestyle drift and overconcentration on Health care.2 Lifestyle drift describes the tendency in public Health to focus on individual behaviors, such as smoking, diet, alcohol, and drugs, that are undoubted causes of Health inequities, but to ignore the drivers of these behaviors—the causes of the causes. Too often Health is equated only with Health care. Lack of access to Health care has dominated the debate in the United States because of egregious inequities in access, despite spending far more on Health care than any other country. A recent study by the Commonwealth Fund found that compared with other countries the US Health system performed relatively poorly in terms of cost, equity, and efficiency.3 The Veterans Health Administration, however, does have a strong focus on equity. The office of Health Equity ensures that the Health care provision for veterans provides equitable care appropriate for the individual’s circumstance and irrespective of geography, gender, race/ethnicity, age, culture, or sexual orientation. There is importance, too, in incorporating socioeconomic factors into provision of equitable access and care. The office of Health Equity also brings an equity focus into organizational discussions of policy, decision-making, resource allocation, practice, and performance plans throughout the Veterans Health Administration—a Health equity in all policies approach that could be extended to other relevant organizations and stakeholders. Universal access to high quality care and a focus on equitable outcomes, then, is central to challenging Health inequities. So too is challenging inequities in social conditions which lead to Health inequalities. Attempts have been made to apportion Determinants of Health status of populations—see Figure 1, showing the relatively significant proportion of inequity attributed to social Determinants. FIGURE 1— Estimates of the contribution of the main drivers of Health status. The Robert Wood Johnson Foundation in the United States also sets out how social factors have as much, or even more impact on Health as the medical care system, and it urges leaders across the United States to shift funding priorities to emphasize 3 areas essential to improving the nation’s Health: Increasing access to early childhood development programs; revitalizing low-income neighborhoods; and broadening the mission of Health care providers beyond medical treatment.5 Important goals, too, for the Veterans Health Administration. In our English review of Health inequalities, in 2010, we enlisted the help of 80 or so experts and set out a large evidence base, which demonstrated the most important influences on Health and Health inequalities.6 We made recommendations in six priority areas. None was in Health care because there is evidence of reasonably equitable, universal access to Health care in England. The six priority areas were: quality of experiences in the early years, education and building personal and community resilience, good quality employment and working conditions, having sufficient income to lead a Healthy life, Healthy environments, and priority public Health conditions—taking a social Determinants approach to tackling smoking, alcohol, and obesity. At the heart of our approach is the finding that Health inequalities are not limited to poor Health for the worst off, or the most socially disadvantaged. There is a striking social gradient in Health and disease running from top to bottom of society.7 The social gradient has now been shown to be widespread across the world in countries at low, middle, and high income.6 Figure 2 shows this gradient in England for life expectancy and Healthy life expectancy. FIGURE 2— Life expectancy and disability-free life expectancy (DFLE) at birth by neighborhood income and deprivation: 1999–2003. There has been considerable progress in the recognition and adoption of the social Determinants of Health approach to Health equity. Internationally, organizations such as the United Nations have expressed their broad commitment to Health equity through action on the social Determinants, and the European Union and World Health Organization have also acted on the social Determinants of Health and adopted this approach at the heart of their Health improvement and Health equity strategies. There have also been advancements at the national level—in many countries national governments have acted. There have been some great strides by local governments and authorities too. In England, 75% of local authorities have adopted this approach. However, and it is a significant however, there are many further challenges to greater Health equity and to the social Determinants of Health.

  • Action on the social Determinants of Health
    Revue d'Épidémiologie et de Santé Publique, 2013
    Co-Authors: Michael Marmot, Ruth Bell, Peter Goldblatt
    Abstract:

    Closing the Gap in a Generation, the final report of the Commission on Social Determinants of Health (CSDH) proposed that inequities in power, money and resources were responsible for much of the inequalities in Health within and between countries. A toxic combination of poor policies and programmes, unfair economic arrangements and bad governance led to inequalities in the conditions of daily life: the circumstances in which people are born, grow, live, work, and age. Our message is that there needs to be a cross-government commitment to action on social Determinants of Health. With this commitment, the knowledge synthesised in our report suggests that there is much that can be done at the practical level.

  • Global action on social Determinants of Health
    Bulletin of the World Health Organization, 2011
    Co-Authors: Michael Marmot
    Abstract:

    Closing the gap in a generation is a rousing call.1 Did the World Health Organization’s Commission on Social Determinants of Health (CSDH) really believe it to be possible? Technically, certainly. Yes, there is a greater than 40-year spread in life expectancy among countries and dramatic social gradients in Health within countries. But the evidence suggests that we can make great progress towards closing the Health gap by improving, as the CSDH put it, the conditions in which people are born, grow, live, work and age. These include ensuring: equity for every child from the start, Healthier environments, fair employment and decent work, social protection across the life course and universal Health care. To make such progress, we must also deal with inequity in power, money and resources – the social injustice that is killing on a grand scale. At a more fundamental level, our vision is to create the conditions so that every person may enjoy the freedoms that lead to improved Health – what we call empowerment. In the three years since Closing the gap in a generation was published, there is no question that there is much to make us gloomy: the global financial crisis and the steps put in place to deal with it have worse impacts on the poor and relatively disadvantaged; the persistence of bad governance nationally and globally; climate change and inequitable measures for mitigation and adaptation and, in many countries, an increase in Health inequity. On the positive side, however, much has happened to support my claim that I am an evidence-based optimist. First at the World Health Organization (WHO) itself, the doubting voices (what do social Determinants have to do with a disease control organization?) were countered by the argument that WHO could not possibly ignore what the CSDH called “the causes of the causes” of ill-Health. Specialists across WHO, who formed the CSDH’s knowledge network on priority public Health conditions, showed that action on social Determinants of Health was fundamental to disease control programmes.2 Importantly, a resolution was passed at the World Health Assembly in 2009 that called on WHO and all Member States to take action on the social Determinants. Each of the WHO Regions has expressed interest in this issue. The WHO Regional office for the Americas will make social Determinants a theme for its publication Health in the Americas 2012, has developed training courses and has been promoting Health equity in the region. Zsuzsanna Jakab, WHO Regional Director for Europe, thought it essential that work be done to adapt the CSDH findings to the diverse countries that make up the WHO European Region. She therefore invited me to lead the European Review of Social Determinants and the Health Divide. The recommendations from this review will feed in to Europe’s new public Health strategy, Health 2020. WHO, with the government of Brazil, is organizing the World Conference on Social Determinants of Health in Rio de Janeiro. Several countries have explicitly taken on the social Determinants of Health agenda. Brazil, Denmark, England, Norway, Scotland and Slovenia are among many countries that have commissioned reviews and/or produced strategies for action on this subject. In other countries such as Argentina, Chile, Costa Rica and Sri Lanka, there is much focus on and concern about the social Determinants of Health and a variety of actions have been taken. The state of South Australia has made the Health in All Policies approach a central plank of government action. India, while not explicitly addressing the social Determinants of Health has, nevertheless, pursued policy initiatives that will have important impact on Health equity. These include: rural employment guarantees, food security, universal Health care, social security for informal workers, education, housing and rights of tribal and forest dwellers. These new policies and programmes are all welcome but the proof will come from monitoring their effect on social Determinants and Health outcomes. The review of Health inequalities in England, published as Fair society, Healthy lives,3 adapted the CSDH recommendations into six domains: (i) give every child the best start in life, (ii) improve education and life-long learning, (iii) create fair employment and jobs, (iv) ensure a minimum income for a Healthy standard of living, (v) build Healthy and sustainable communities, and (vi) apply a social Determinants’ approach to prevention. In the wake of this review there are encouraging signs of impact on policy and practice at national and local level in the United Kingdom of Great Britain and Northern Ireland. The ambition of the CSDH was to create a global movement for social Determinants and Health equity. As the global community gathers in Rio de Janeiro in October for the conference on social Determinants of Health, we are at a crucial juncture. Will the call for social justice and the need to formulate all policies to benefit Health equity remain something, at best, honoured in speech alone? Or will the global community recognize that action on social Determinants of Health is not only vital for Health equity but has other highly desirable societal outcomes including social cohesion, reduction of crime and civil unrest, a more educated workforce and the freedom for people to lead lives they have reason to value.4

  • Action on the Social Determinants of Health and Health Inequities Goes Global
    Annual review of public health, 2011
    Co-Authors: Sharon Friel, Michael Marmot
    Abstract:

    Marked Health inequities exist between regions, between countries, and within countries. Reducing these inequities in Health requires attention to the unfair distribution of power, money, and resources and the conditions of everyday life. These are the social Determinants of Health. The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) brought together a global evidence base of what could be done to reduce these Health inequities, demonstrating that economic and social policy, if done well, can improve Health and Health equity. A global movement for Health equity was reignited by the WHO Commission on Social Determinants of Health when it made a call to action upon delivering its final report.

  • The Solid Facts: the social Determinants of Health
    Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals, 1999
    Co-Authors: Michael Marmot
    Abstract:

    The author describes the top ten messages arrived at from the results of research on the social Determinants of Health. He was approached to put them into a form so simple that even policy makers could use it. (non-author abstract)

Laura M Gottlieb - One of the best experts on this subject based on the ideXlab platform.

  • meanings and misunderstandings a social Determinants of Health lexicon for Health care systems
    Milbank Quarterly, 2019
    Co-Authors: Hugh Alderwick, Laura M Gottlieb
    Abstract:

    Policy Points Health care systems and policymakers in the United States increasingly use language related to social Determinants of Health in their strategies to improve Health and control costs, but the terms used are often misunderstood, conflated, and confused. Greater clarity on key terms and the concepts underlying them could advance policies and practices related to social Determinants of Health-including by defining appropriate roles and limits of the Health care sector in this multisector field.

  • moving electronic medical records upstream incorporating social Determinants of Health
    American Journal of Preventive Medicine, 2015
    Co-Authors: Laura M Gottlieb, Karen J Tirozzi, Rishi Manchanda, Abby R Burns, Megan Sandel
    Abstract:

    Background Knowledge of the biological pathways and mechanisms connecting social factors with Health has increased exponentially over the past 25 years, yet in most clinical settings, screening and intervention around social Determinants of Health are not part of standard clinical care. Electronic medical records provide new opportunities for assessing and managing social needs in clinical settings, particularly those serving vulnerable populations. Purpose To illustrate the feasibility of capturing information and promoting interventions related to social Determinants of Health in electronic medical records. Methods Three case studies were examined in which electronic medical records have been used to collect data and address social Determinants of Health in clinical settings. Results From these case studies, we identified multiple functions that electronic medical records can perform to facilitate the integration of social Determinants of Health into clinical systems, including screening, triaging, referring, tracking, and data sharing. Conclusions If barriers related to incentives, training, and privacy can be overcome, electronic medical record systems can improve the integration of social Determinants of Health into Healthcare delivery systems. More evidence is needed to evaluate the impact of such integration on Health care outcomes before widespread adoption can be recommended.

Jessica Allen - One of the best experts on this subject based on the ideXlab platform.

  • social Determinants of Health equity
    American Journal of Public Health, 2014
    Co-Authors: Michael Marmot, Jessica Allen
    Abstract:

    Language is important. The call for papers in this supplement was entitled Health equity. Yet the call asked for papers that address disparities in Health. In the United States, disparities, most often, has been used to refer to racial/ethnic differences in Health, or more commonly Health care. We note that the call in this supplement expands the focus and highlights differences by socioeconomic status and geographic location, among others. By tradition, in the United Kingdom we have used the term inequalities to describe the differences in Health between groups defined on the basis of socioeconomic conditions. To reduce Health inequalities requires action to reduce socioeconomic and other inequalities. There are other factors that influence Health, but these are outweighed by the overwhelming impact of social and economic factors—the material, social, political, and cultural conditions that shape our lives and our behaviors. Much of the evidence describing this was set out in the World Health Organization Global Commission on the Social Determinants of Health.1 In fact, so close is the link between social conditions and Health, that the magnitude of Health inequalities is an indicator of the impact of social and economic inequalities on people’s lives. Health then becomes an important further cause for concern about the rapid increase in inequalities of wealth and income in our societies. Increasingly, we are using the language of Health inequity to describe those Health inequalities that, though avoidable, are not avoided and hence are unfair. Two particular issues stand in the way before we can act on knowledge of social Determinants of Health to address Health equities: lifestyle drift and overconcentration on Health care.2 Lifestyle drift describes the tendency in public Health to focus on individual behaviors, such as smoking, diet, alcohol, and drugs, that are undoubted causes of Health inequities, but to ignore the drivers of these behaviors—the causes of the causes. Too often Health is equated only with Health care. Lack of access to Health care has dominated the debate in the United States because of egregious inequities in access, despite spending far more on Health care than any other country. A recent study by the Commonwealth Fund found that compared with other countries the US Health system performed relatively poorly in terms of cost, equity, and efficiency.3 The Veterans Health Administration, however, does have a strong focus on equity. The office of Health Equity ensures that the Health care provision for veterans provides equitable care appropriate for the individual’s circumstance and irrespective of geography, gender, race/ethnicity, age, culture, or sexual orientation. There is importance, too, in incorporating socioeconomic factors into provision of equitable access and care. The office of Health Equity also brings an equity focus into organizational discussions of policy, decision-making, resource allocation, practice, and performance plans throughout the Veterans Health Administration—a Health equity in all policies approach that could be extended to other relevant organizations and stakeholders. Universal access to high quality care and a focus on equitable outcomes, then, is central to challenging Health inequities. So too is challenging inequities in social conditions which lead to Health inequalities. Attempts have been made to apportion Determinants of Health status of populations—see Figure 1, showing the relatively significant proportion of inequity attributed to social Determinants. FIGURE 1— Estimates of the contribution of the main drivers of Health status. The Robert Wood Johnson Foundation in the United States also sets out how social factors have as much, or even more impact on Health as the medical care system, and it urges leaders across the United States to shift funding priorities to emphasize 3 areas essential to improving the nation’s Health: Increasing access to early childhood development programs; revitalizing low-income neighborhoods; and broadening the mission of Health care providers beyond medical treatment.5 Important goals, too, for the Veterans Health Administration. In our English review of Health inequalities, in 2010, we enlisted the help of 80 or so experts and set out a large evidence base, which demonstrated the most important influences on Health and Health inequalities.6 We made recommendations in six priority areas. None was in Health care because there is evidence of reasonably equitable, universal access to Health care in England. The six priority areas were: quality of experiences in the early years, education and building personal and community resilience, good quality employment and working conditions, having sufficient income to lead a Healthy life, Healthy environments, and priority public Health conditions—taking a social Determinants approach to tackling smoking, alcohol, and obesity. At the heart of our approach is the finding that Health inequalities are not limited to poor Health for the worst off, or the most socially disadvantaged. There is a striking social gradient in Health and disease running from top to bottom of society.7 The social gradient has now been shown to be widespread across the world in countries at low, middle, and high income.6 Figure 2 shows this gradient in England for life expectancy and Healthy life expectancy. FIGURE 2— Life expectancy and disability-free life expectancy (DFLE) at birth by neighborhood income and deprivation: 1999–2003. There has been considerable progress in the recognition and adoption of the social Determinants of Health approach to Health equity. Internationally, organizations such as the United Nations have expressed their broad commitment to Health equity through action on the social Determinants, and the European Union and World Health Organization have also acted on the social Determinants of Health and adopted this approach at the heart of their Health improvement and Health equity strategies. There have also been advancements at the national level—in many countries national governments have acted. There have been some great strides by local governments and authorities too. In England, 75% of local authorities have adopted this approach. However, and it is a significant however, there are many further challenges to greater Health equity and to the social Determinants of Health.

Clare Bambra - One of the best experts on this subject based on the ideXlab platform.

  • The social and behavioural Determinants of Health in Europe: findings from the European Social Survey (2014) special module on the social Determinants of Health.
    European journal of public health, 2017
    Co-Authors: Tim Huijts, Per Gunnar Stornes, Terje Andreas Eikemo, Clare Bambra
    Abstract:

    Background Previous studies comparing the social and behavioural Determinants of Health in Europe have largely focused on individual countries or combined data from various national surveys. In this article, we present the findings from the new rotating module on social Determinants of Health in the European Social Survey (ESS) (2014) to obtain the first comprehensive comparison of estimates on the prevalence of the following social and behavioural Determinants of Health: working conditions, access to Healthcare, housing quality, unpaid care, childhood conditions and Health behaviours. Methods We used the 7th round of the ESS. We present separate results for men and women. All estimates were age-standardized in each separate country using a consistent metric. We show country-specific results as well as pooled estimates for the combined cross-national sample. Results We found that social and behavioural factors that have a clear impact on physical and mental Health, such as lack of Healthcare access, risk behaviour and poor working conditions, are reported by substantial numbers of people in most European countries. Furthermore, our results highlight considerable cross-national variation in social and behavioural Determinants of Health across European countries. Conclusions Substantial numbers of Europeans are exposed to social and behavioural Determinants of Health problems. Moreover, the extent to which people experience these social and behavioural factors varies cross-nationally. Future research should examine in more detail how these factors are associated with physical and mental Health outcomes, and how these associations vary across countries.

Colleen Reid - One of the best experts on this subject based on the ideXlab platform.

  • A REVIEW of RELATIONSHIPS BETWEEN ACTIVE LIVING AND Determinants of Health
    Social science & medicine (1982), 1998
    Co-Authors: C. James Frankish, C.dawne Milligan, Colleen Reid
    Abstract:

    Identifies approaches to the conceptualization of 'Determinants of Health,' 'leisure activities,' and 'active living.' Relationships between Determinants of Health (gender, age, education, race, social support, place of residence, socioeconomic factors, occupation, Health behaviors, activity choices and leisure constraints) and levels and patterns of active living are reviewed. Relationships between Determinants of Health and active living are summarized within the context of an integrative framework: the precede-proceed model of Health promotion planning and evaluation. The model's use highlights the need to link the historically individual-focused literature on physical activity/active living with the emerging recognition that sociocultural and structural Determinants play a key role in influencing a wide range of activities in daily life.Peer reviewedFinal article published.Determinants of Healthlevelsevaluationfactors of active living within precede-proceed model of Health promotion plannin