Health care only accounts for 10% of a population’s health

29 June 2017

Bernard Baruch, a US philanthropist, said that ‘the ability to express an idea is well nigh as important as the idea itself’.

This chimes with my conclusions from spending the last 18 months exploring what the Foundation can do to support action on the social determinants of health.

The evidence of how day-to-day experiences in our homes, communities and workplaces shapes our long term health has been long understood. More recently, people have sought to quantify the influence of different factors on our overall health. And while estimates vary, it is largely accepted that access to health care only accounts for around 10% of a population’s health, with the rest being shaped by socio-economic factors.

Despite this evidence, I have been surprised by how little this is understood outside the public health community. Over the past year, in dozens of conversations, I have found this news has come as a surprise to many people, from politicians to journalists, bankers to teachers.

Interestingly though, once they have got over the initial surprise, the case seems self-evident. So, the questions that have been niggling me are: Why is it that such well-established evidence, which mirrors people’s lived experience, is so little understood? And, if the social determinants evidence was better understood, what action would this knowledge unleash?

Clearly, there will be many social and cultural issues at play but my best guesses are that this gap in understanding stems in part from:

  • the term ‘health’ having defaulted to being used as a description of a sector or service (ie the NHS) rather than an individual attribute. When the experts use this shorthand, it isn’t surprising that the lay listener is left thinking ‘health = health care’
  • the prevailing political discourse that has led us to believe that whether we are healthy or not is driven by our individual choices rather than a recognition that choice is constrained and influenced by our environment and life opportunities
  • the public health community rarely being invited into the debate on the macro issues that relate to social determinants. The times a public health expert is heard in the media explaining the health impacts of, for instance, squeezing family income, the housing crisis, the precarious job market or the loss of green space are few and far between.

We have seen from the climate change movement that galvanising political action requires the evidence and a broad-based concern and desire for change. We have the evidence when it comes to social determinants of health, so the challenge we are hoping to address through our strategy is how we can express the idea in a way that garners cross-sector support.

Over the next few years, the Health Foundation will be actively working, often in partnership with others, to raise awareness and understanding of the social determinants of health and encourage more joined up thinking and action.

  • Starting with our new infographics series, we want to bring to life the evidence and showcase examples of how a range of factors – such as our surroundings, our housing, and our jobs – influence our health. Sir Michael Marmot’s blog this month introduces this evidence base with some startling facts and examples. We want these messages to reach far and wide, beyond the public health community, so that we can build relationships and alliances to help unleash action to improve people’s health.
  • Work is underway with the Frameworks Institute, a communications research institute, who are helping us to understand how we can best build public understanding of the factors that influence our health. Central to this is recognising that there is a gap in understanding between what the experts say and what the public hears, and that effective communication requires us to identify and tailor our explanations to the social and cultural norms that create this gap.
  • In partnership with the Royal Society of Public Health, we are taking a creative approach to capture people’s imagination and build their understanding of the social determinants of health. We will shortly be publishing entries from our dystopian short story competition. The stories explore a future in which some of the current trends in the social determinants of health go unchecked.
  • In this month’s newsletter I also talk to Julia Unwin, strategic adviser on our children and young people inquiry, about how we hope this work will build our understanding of what’s influencing the health of our future adults. My colleague Jane Landon also tells us more about another piece of work which will collate international evidence about successful policy making for public health in other countries.

Great work is already going on all over the country, from innovative ideas for boosting mental health in the workplace, to the individuals working hard to improve health in schools.

I am sure we are not alone is seeing the need to communicate this evidence more effectively to the public, the media, policy makers and the politicians. The potential prize in spreading the evidence about what works to improve the health of the population is huge. We would welcome the opportunity to join with others in this goal.

Jo Bibby (@JoBibbyTHF) is Director of Strategy at the Health Foundation

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