Social determinants of health

Rizka Maulida
Apa yang Anda ketahui mengenai “social
determinants of health”? Definisi?
 WHO Commission on
the Social Determinants of Health (2008)

The social determinants of health are the

conditions in which people are born, grow, live,
work and age.
• These circumstances are shaped by the
distribution of money, power and resources at
global, national and local levels.

• The social determinants of health are mostly

responsible for health inequities - the unfair
and avoidable differences in health status
seen within and between countries.
 Health People 2020
Neighborhood
and Built
Environment

Economic Health and

Stability Health Care

SDOH

Social and
Education Community
Context
Why are some nations healthy and
others not?
 Global
Life expectancy Life expectancy Life expectancy
at birth (years) at birth (years) at birth (years)

Year Both sexes Male Female

2015 71.4 69.1 73.7

2005 68 65.8 70.2

2000 66.4 64.1 68.7

 Africa
Life expectancy Life expectancy Life expectancy
at birth (years) at birth (years) at birth (years)

Year Both sexes Male Female

2015 60 58.3 61.8

2005 53 51.8 54.2

2000 50.6 49.3 52

 Americas
Life expectancy Life expectancy Life expectancy
at birth (years) at birth (years) at birth (years)

Year Both sexes Male Female

2015 76.9 74 79.9

2005 74.9 71.9 78

2000 73.7 70.6 76.9

 South-east Asia
Life expectancy Life expectancy Life expectancy
at birth (years) at birth (years) at birth (years)

Year Both sexes Male Female

2015 69 67.3 70.7

2005 65.4 64.2 66.7

2000 63.5 62.4 64.7

 Europe

Life expectancy Life expectancy Life expectancy

at birth (years) at birth (years) at birth (years)

Year Both sexes Male Female

2015 76.8 73.2 80.2

2005 73.2 69.1 77.4

2000 72.3 68.1 76.5

 Eastern Mediterranean
Life expectancy Life expectancy Life expectancy
at birth (years) at birth (years) at birth (years)

Year Both sexes Male Female

2015 68.8 67.3 70.3

2005 66.1 64.6 67.7

2000 65.4 64 66.9

 Western Pacific
Life expectancy Life expectancy Life expectancy
at birth (years) at birth (years) at birth (years)

Year Both sexes Male Female

2015 76.6 74.5 78.7

2005 74.4 72.3 76.7

2000 72.5 70.3 74.8

What explains cross-national health
inequalities?

• Healthcare
• Lifestyles
• Socialenvironment
 • Lifestyles
• Genetic
• Social environment
The immigration effect suggests that --

• American environment is “obesogenic”.

• Everybody is at risk.
• So we should stop blaming individuals.
• And start thinking about curing the
environment.
 The Strategy of Preventive Medicine
by Geoffrey Rose

• What is “normal” BMI in one society can be

quite abnormal in another.
• Targeting prevention efforts to the high risk
tail of the distribution of body mass will make
a limited impact on prevention.
• Whole societies might be “at risk”.
“Upstream” drivers of the obesity epidemic

• ↑automobile reliance
• marketing empty calories to children
• ↑portion sizes
• ↓walkability of residential neighborhoods
• ↓ physical activity programs in schools.
• ↑time squeeze among workers & the decline
in slow-cooked food...
“Upstream” Strategies to Prevent Obesity

• Educating the public

Nutrition Labeling and Education Act, 1990

• Altering incentives for healthy behavior.

Taxing sugary sodas and subsidizing healthy food
options.

• Legislation/regulations.
Attempted municipal ban on sales of large-size sugary
beverages by Mayor Bloomberg, NY City 2012.
Why it’s difficult to engage policy
makers on social determinants?
• Identifiable vs. statistical beneficiaries.
• Conflation of health and health care.
• Conflict between time horizon for political
decision-making and payoff from investments
in social determinants.
(https://www.cdc.gov/socialdeterminants/policy/index.htm)