WHO: The Solid Facts (2003) Europe

"Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich..."

Introduction

This document explains what the World Health Organization means by the social determinants of health. They refer to the factors which either keep people in life or threaten their health. In some ways they are common sense: for example, we all know that being poor is bad for our health and experiencing love and support is good for our well-being. What is different now is that there is a vast amount of research to show just how much these factors influence our health.

The social determinants approach has not often been applied to men’s health but there are some steps in this direction (see Publications, John J. Macdonald and the Australian National Male Health Policy). We must remember that this document gives some examples from a European context and should serve as a point of reference for reflection for different contexts. WHO has continued to promote the same ideas in the Final Report of the Global Commission on the Social Determinants of Health) and with a Framework document in 2011.

Lower education levels are linked with lower incomes and limited access to good housing, healthy foods and access to health care, and shorter life expectancy as a result. Health and illness are heavily influenced by our environment and the context of our lives. For example: encouraging people to eat healthy foods when it is expensive and not readily available can be counterproductive.

In the area of men and social determinants of health, various factors will affect their health. For example: Men spend an average of one third of their life at work and many men derive their identities from their employment. Insecure, low paying jobs with little or no control or unemployment will decrease the likelihood of eating healthy foods and gaining access to health services, as well as increasing stress levels that may lead to addictions and even shorten people’s lives. Similarly, men who have stable finances, a good job, and experience lower levels of stress and strong social support will live longer and healthier lives.

Overview

The Solid Facts (2003) identifies 10 social determinants of health:

• The social gradient
• Stress
• Early Life
• Social exclusion
• Work
• Unemployment
• Social support
• Addiction
• Food
• Transport

Previously, the social determinants of health were only discussed among academics, but that has changed and they are increasingly becoming more known among the wider population. The focus should be on the social and economic conditions that make people ill and in need of medical attention, rather than prolonging survival and improving prognosis after a serious illness.

This publication highlights and examines the most important social determinants of health, and explains how psychological and social influences affect physical health and longevity. It also shows how public policy can shape a social environment that supports better health.

The evidence from this publication is based on many thousands of research reports. Some of the studies have used prospective methods, following tens of thousands of people over decades - sometimes from birth. Others have used cross-sectional methods, where individual, area, national or international data has been studied. Evidence from intervention studies have also been used when determining causality, and at times studies from other primate species. The majority of evidence in this publication comes from rich developed countries and may have limited relevance to less developed countries.