When most people think about the health of individuals, communities, and populations they think of access to healthcare. People in developing countries have a definite lack of access to doctors, nurses, drugs, and the latest medical technologies.  It is important to remember that the conditions people are born into also have a significant and lasting affect on their health. These circumstances are shaped by the distribution of power and resources both globally and locally. These factors are known as the “Social Determinants of Health”

The social determinants of health are the social, economic, and political factors that shape the health of individuals, communities, and nations. Social determinants of health include both environmental resources such as housing, income and income distribution, unemployment, early life, education, and food insecurity.  They also include gender, ethnicity, class, and race.

The social determinants of health are responsible for health inequities. Health inequities are the large discrepancies in health status seen between countries and within countries. Wealthier countries in the developed world have much lower rates of infant mortality. The infant mortality rate is the number of infants who die before they reach age one, per 1000 births in any year.

The World Bank reports that Sweden, Norway, and Japan have an infant mortality rate of only two in 2012. The US is three times higher at six deaths per 1000 live births. Unfortunately, in many countries in sub Saharan Africa approximately 10% of children die before their first birthday. The infant mortality rate in Sierra Leone was 117 in 2012.

Another factor used to measure the health of nations that is largely impacted by the social determinants of health is life expectancy at birth. Countries in sub Saharan Africa fare the worst; Sierra Leone has a life expectancy of 45 years and Mozambique has a life expectancy of 49 years. High-income countries fare much better; Japan and Switzerland have average life expectancies of 83. The United States has an average life expectancy of 79 years.  Inequality within a country also has a large impact on the overall health of a nation. The U.S. has one of the highest rates of inequality in the world. This is why the US does not fare as well as other developed countries in infant mortality rates and life expectancy.

Health inequities are considered to be unfair and avoidable. It is widely considered that health inequities could be abolished with improved social policies and programs and great income iquality. At the World Conference on the Social Determinants of Health in 2011 the WHO developed five action areas for improving health equity:

1.    Adopt improved governance for health and development

2.    Promote participation in policy making and implantation

3.   Further reorient the health sector towards promoting health and reducing health inequities

4.   Strengthen global governance and collaboration

5.   Monitor progress and increase accountability

– Lisa Toole 

Sources: The World Bank, WHO, CDC, NCBI