Addressing the social determinants of health How do you eat an elephant?

Some people might think it’s a bit ambitious to attempt to produce a ‘quick guide’ to the social determinants of health – the social, cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age. But, despite the vastness of the topic, we decided to give it a go.

The social determinants of health: what are the key messages?

Firstly, we should care about good health because it’s essential if individuals, society and the economy are to thrive. I recently read that ‘all members of a community are affected by the poor health status of its least healthy members’. Whether your cause is social justice or economic development, or you’re interested in social cohesion, good health is a relevant piece of the puzzle.

Secondly, health is about more than health care. When people are asked about health, their thought process often leads them straight to illness, medicine and the treatment of disease. But many of the drivers of health sit outside of health and social care. As Michael Marmot puts it, ‘Why treat people and then send them back to the conditions that made them sick?’

Thirdly, as individuals, we have less control than we think. The factors that make us healthy sit largely outside of individual control and it is the conditions in which we find ourselves living that make us healthy, or unhealthy – consider the greater density of fast food outlets in deprived areas in England. This is echoed in a recent report by Guy’s & St Thomas’ Charity about inner city childhood obesity, which found ‘it is in these areas in particular where people are bombarded with opportunities to eat high energy food and have less defence against ‘obesogenic’ city environments that promote unhealthy choices.'

Finally, collectively, we need to create the surroundings that give people the opportunity to be healthy. As set out in the Health Foundation’s quick guide, the evidence shows that many people and sectors have the levers to improve people’s health and reduce health inequalities (the differences in health outcomes that exist between groups in society). This includes people sitting across government, the voluntary sector, the private sector, media, advertising and local communities. But if we don’t understand and act on this knowledge, we will never overcome our biggest health challenges.

What are the opportunities for addressing the social determinants of health?

As part of producing this quick guide, we conducted a series of informal interviews with experts in the field, many of whom were directors of public health. They told us about some of the challenges they face when influencing action on the social determinants of health.

Public health moved to local government in 2013, and this represents a huge opportunity for public health to continue influencing other local government departments, such as economic development and transport. However, throughout our conversations, it became clear that while a lot of people ‘get’ the social determinants of health, there is still a lack of understanding among some (outside of public health) and a lack of commitment to take action across the spectrum of society.

This is partly because not everyone is aware that what they do has an impact on people’s health and on health inequalities. Why should they be? When a transport planner is thinking about how they can connect a deprived community to a town centre, jobs and services, they may not necessarily be aware of the benefits that this will generate for people’s health.

Yet so many people can make a difference. It could be a charity that helps a group of people feel less lonely, an employer who decides to become a Living Wage employer, or a councillor who puts cyclists and pedestrians first when coming up with an action plan to tackle traffic congestion. The list of those with the power to influence our daily lives for the better (often through structural changes) – and therefore our health – is long.

What is already happening?

We uncovered some great examples, particularly at local and regional level, of where, despite the odds stacked against them (such as severe budget cuts), action is being taken that will improve people’s opportunities for healthy lives.

Read our quick guide, What makes us healthy? An introduction to the social determinants of health, to find out more about:

• how local councils are using innovative inclusive economic growth techniques
• how local councils are making the most of planning and transport policies to design and create healthy places
• how charities and businesses can influence health
• what approaches national governments are taking.

What’s my aspiration for this quick guide?

My hope is that this quick guide will make its way to those people across society who have the potential to influence people’s health, and that they might pick it up and think, ‘This is about me and the work I do.’ Perhaps a public health expert will pass it on to a director of economic development and planning, who will pass it on to a business leader or employer they are working with, who might then be able to ask themselves important questions, such as, ‘Did the last decision I make have an impact on people’s health?’.

The quick guide sits within a broader programme of work at the Health Foundation. It offers a broad overview of the interconnectedness of virtually every aspect of people’s daily lives and their health – and, therefore, the dizzying potential that exists for people across society to take action.

Order a free copy of the quick guide now. It will fit right into your pocket.

Oh, and the answer as to how you eat an elephant? Piece by piece.

Natalie Lovell is a Policy Analyst for the Health Foundation