Social determinants of health

Closing the gap in a generation - how?


Improve daily living conditions

Equity from the start

At least 200 million children globally are not achieving their full potential. This has huge implications for their health and for society at large. Investment in early years provides one of the greatest potentials to reduce health inequities. The Commission calls for:

  • an interagency mechanism to be set up to ensure policy coherence for early child development;
  • a comprehensive package of quality programmes for all children, mothers and caregivers; and
  • the provision of quality compulsory primary and secondary education for all children.

Healthy places, healthy people

Where we live affects our health and chances of living flourishing lives. Last year saw, for the first time, the majority of human beings living in urban settings. Almost 1 billion live in slums. The daily conditions in which people live have a strong influence on health equity. Access to quality housing and clean water and sanitation are human rights. The Commission calls for:

  • greater availability of affordable housing by investing in urban slum upgrading including, as a priority, provision of water, sanitation and electricity;
  • healthy and safe behaviours to be promoted equitably, including promotion of physical activity, encouraging healthy eating and reducing violence and crime through good environmental design and regulatory controls, including control of alcohol outlets;
  • sustained investment in rural development; and
  • economic and social policy responses to climate change and other environmental degradation that take into account health equity.

Fair employment and decent work

Employment and working conditions have powerful effects on health equity. When these are good, they can provide financial security, social status, personal development, social relations and self-esteem, and protection from physical and psychosocial illness. The Commission calls for:

  • full and fair employment and decent work, to be a central goal of national and international social and economic policy-making;
  • economic and social policies that ensure secure work for men and women with a living wage that takes into account the real and current cost of healthy living;
  • all workers to be protected through international core labour standards and policies; and
  • improved working conditions for all workers.

Social protection throughout life

Everyone needs social protection throughout their lives, as young children, in working life, and in old age. People also need protection in case of specific shocks, such as illness, disability, and loss of income or work. Four out of five people worldwide lack the back-up of basic social security coverage. Extending social protection to all people, within countries and globally, will be a major step towards achieving health equity within a generation. The Commission calls for:

  • establishing and strengthening universal comprehensive social protection policies;
  • ensuring social protection systems include those who are in precarious work, including informal work and household or care work

Universal Health Care

Access to and utilization of health care is vital to good and equitable health. Without healthcare, many of the opportunities for fundamental health improvement are lost. Upwards of 100 million people are pushed into poverty each year through catastrophic household health costs. The Commission calls for:

  • healthcare systems to be based on principles of equity, disease prevention, and health promotion with universal coverage, focusing on primary health care, regardless of ability to pay.
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