Marmot - social determinants

My view, based on my own lifetime of research, and the compilation of evidence from other people’s research, is if you look at what has happened to health in different countries over time, the key determinants of the improvement in health have been the social determinants. Societies get healthier in general when they develop. When they have no military, and good education, early child development, gender equity, good employment and working conditions, get rid of the slums and so on. These are all very important. It doesn’t mean health systems are unimportant, they’re key as well. But this big picture of saying that health is a result of development, and development, not just economic growth, but broader social development, this big picture is absolutely vital because otherwise, it’s in a way accepting “Well people are going to get sick for whatever reason and we’d better make sure we’ve got health care systems in place to deal with it when they get sick” without actually looking at the circumstances of people’s lives that lead to that sickness. When we began the commission we said “What’s the point of treating people when they get sick and then sending them back to the conditions that made them sick in the first place?”

“Shouldn’t we both treat them, and try and improve the conditions so that the likelihood of getting ill in the first place is lessened?” Now, with the global commission, we were dealing with Sub-Saharan Africa, and Latin America, and South Asia, and North America and Europe and so on. It’s very difficult to have one set of recommendations that apply to all those different countries.

That means first, presumably accepting the general orientation and the general findings of the commission but then for example, what we did in the UK, the British government invited me to conduct a review of what the commission’s findings meant for one country. And we did a report, we convened nine task groups to rereview the evidence, and for example, coming back to early child development, what our task group on early child development and education said, “if you want to reduce inequalities in early child development and education, you have to reduce inequalities in society”. I think that’s a key message.