The Commission on Social Determinants of Health: Tackling the Social Roots of Health Inequities

Throughout the world, people who are vulnerable and socially disadvantaged have less access to health resources, get sicker, and die earlier than people in more privileged social positions. Health equity gaps are growing today, despite unprecedented global wealth and technological progress [1,2]. The greatest share of health problems is attributable to the social conditions in which people live and work, referred to as the social determinants of health (SDH) [3–5]. Good medical care is vital to the well-being of populations, but improved clinical care is not enough to meet today’s major health challenges and overcome health inequities. Without action on social determinants, those countries in greatest need will neither meet the health-related Millennium Development Goals nor achieve global targets for reducing chronic diseases such as cardiovascular diseases, cancer, and diabetes [6]. Problems are especially urgent in developing countries where the burden of chronic illnesses is growing rapidly on top of the burden of unresolved infectious epidemics. In developing countries—including Brazil, China, India, and Pakistan—death rates from chronic diseases already far exceed the combined death rates from communicable diseases, maternal and perinatal conditions, and nutritional defi ciencies [7]. Modifi able risk factors for chronic illness—such as poor diets, alcohol abuse, and smoking—are often seen as individual “lifestyle choices.” But such choices are conditioned by patterns of material deprivation and social exclusion. Health-compromising behaviors are disproportionately concentrated in socially disadvantaged groups, both in developed and in developing countries [8]. Effective policy to tackle health challenges must address the underlying social conditions that make people who are disadvantaged more vulnerable [9,10]. Ministries of health cannot transform social conditions single-handedly. However, the health sector can take leadership in advancing an approach to health policy that incorporates actions on SDH across government departments and the wider society. To advance this understanding of health as an integrative, cross-governmental goal and to support countries and global health partners in taking action on the social dimensions of health, the The Commission on Social Determinants of Health: Tackling the Social Roots of Health Inequities Alec Irwin, Nicole Valentine, Chris Brown, Rene Loewenson, Orielle Solar, Hilary Brown, Theadora Koller, Jeanette Vega