Social determinants of health - what doctors can do

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Social Determinants of Health – What Doctors Can Do
October 2011


Social Determinants of Health - What Doctors Can Do

Foreword by Sir Michael Marmot

It has been an honour to serve as President of the British Medical Association. During my tenure I have been struck, but not surprised, by members’ utter commitment to improving the health, not just ofindividual patients, but of society as a whole.

However, as I mentioned in my presidency acceptance speech, I was surprised at being approached to be president at all. My work has been focused on inequalities in health where I have emphasised the circumstances in which people are born, grow, live, work, and age rather than anything specifically to do with health care provision. I have emphasised notjust the causes of health inequalities—behaviours, biological risk factors—but the causes of the causes. The causes of the causes reside in the social and economic arrangements of society: the social determinants of health. More than that though more recently my work has looked at what can be done to address these issues across the life-course.

As the year progressed I could see more and morehow my tenure at the BMA and my work on the social determinants of health were a perfect fit. Time after time I was faced with examples where doctors were working tirelessly to increase fairness and social justice by acting on the social determinants of health to reduce health inequalities. Some of these fantastic examples are included in this report.

Just as completing my most recent work,Fair Society, Healthy Lives, was not the end of my journey to address health inequalities, neither does the end of my Presidency signal an end to what I think doctors can do to address the social determinants of health. I urge you to look at the population you serve, the communities in which you work, the people you employ and the teams in which you work to think about how you can use the evidenceand examples in this paper and others to take ever more action to reduce health inequalities.

As I said at the close of my acceptance speech last year, dream with me of a fairer world, but let us take the pragmatic steps necessary to achieve it. I am delighted that the BMA has taken the opportunity to write this paper to take this issue further.




Introduction What arethe Social Determinants of Health? Why should this be a concern of doctors? Practising Holistic Medicine The interaction of social factors Unemployment and Poverty Housing Ill health prevention strategies The NHS as an employer

4 7 12 14 16 17 19 21 22

What can doctors do? (including action grid to help inform activity) 24 Conclusions 25



In June 2010 Sir MichaelMarmot made his inaugural address to the British Medical Association’s annual meeting. He presented his work on the social determinants of health, and received a standing ovation. Association members recognised his call to action to make a difference to reduce the numbers of lives blighted or wasted to preventable causes, the social determinants of health. Members recognised the important role theyhave and that, as a matter of social justice, welcomed the concept that measurements of population health and well-being is also a matter of social capital. The BMA committed to working with Sir Michael, beyond his presidency, to make a difference to the effect of these social determinants on the health of their patients.

It has long been recognised that there are significant differences in thelife and health expectancy between populations within every country. In the United Kingdom the evidence comes from, amongst other sources, the Whitehall studies and more recently Sir Michael’s review of health inequalities in England, Fair Society, Healthy Lives . In essence these show that the differences in health and life expectancy follow the same gradient as wealth and social class....
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