Social Determinants of Health

• The 2015 Baltimore riots, triggered by a Black man's death in police custody, stemmed from deep-rooted socio-economic inequalities.
• A 20-year gap in male life expectancy exists between Baltimore's deprived inner city and affluent areas like Roland Park illustrating health disparities.
• Social determinants of health are the conditions in which people are born, grow, live, work, and age.
• Social determinants of health also include inequities in power, money, and resources that shape daily life conditions.
• Health inequalities are observed both within and between countries, necessitating examination at both levels.
• Middle-income countries face health challenges similar to high-income countries, such as non-communicable diseases and external causes of death.
• Social determinants are highly relevant to communicable diseases in low-income countries.
• Trade, financial flows, treaties, and overseas development assistance are global-level social determinants impacting health.

Poverty and Affluence

• Both absolute and relative poverty significantly impact health outcomes.
• Comparing LeShawn from Baltimore's deprived Upton/Druid Heights and Bobby from affluent Roland Park illustrates the impact of poverty.
• LeShawn's neighborhood, Upton/Druid Heights, had a median household income of $17,000 in 2010, with many facing educational challenges and high arrest rates.
• Roland Park, where Bobby grew up, had a median income of $90,000, with high educational achievements and low arrest rates.
• The lack of gun control exacerbates the impact of deprivation on crime rates.
• Disadvantage accumulates throughout life and isclosely linked to race due to discrimination.
• Average income per person in India was $3,300, yet male life expectancy is higher than in Upton/Druid, highlighting the impact of relative deprivation.
• Relative inequality translates into absolute inequality with respect to capabilities, impacting what individuals can do with their resources.
• The availability of good child services, quality education, free healthcare, and affordable housing can mitigate the impact of low income.
• Amartya Sen emphasizes the importance of having the freedom to lead a life one values, which is linked to empowerment.
• Factors such as disrupted childhoods, poverty, discriminatory environments, and crime hinder social integration and de-prioritize healthy lifestyle choices.

Social Gradient in Health

• The Whitehall studies demonstrate a social gradient in health among British civil servants, where higher employment status correlates with better health and longer life expectancy.
• Studies in the USA indicate a gradient by years of education, with more education correlating with better health.
• The Marmot Review shows gradients in life expectancy and disability-free life expectancy based on area deprivation levels in England.
• Health inequalities exist across the entire social hierarchy, not just between the very rich and very poor.
• There is a need to understand why health inequalities span the social hierarchy and how this understanding applies globally.
• Health inequalities affect everyone, not just the poor, with those in the middle of the social hierarchy experiencing fewer years of healthy life compared to those at the top.
• Rising mortality rates among US Whites aged 45–54, particularly those with fewer years of education, are linked to drug and alcohol poisonings, suicide, and chronic liver disease.

Equity and Early Interventions

• Inequalities in social and economic conditions throughout life cause health inequalities, beginning with early child development.
• Poverty limits children’s intellectual and social development, creating a social gradient in readiness for school.
• Social and economic conditions influence parenting, with strategies needed to reduce poverty and support families.
• Countries which use tax and benefit systems have achieved low levels of child poverty which is associated with better early child development.
• High-quality services that support families, such as state-subsidized child care with trained professionals, are essential.
• Investments in pre-school education correlate with higher performance in schools, as seen in the Programme on International Student Assessment (PISA).
• Adverse Childhood Experiences (ACE) study shows that more types of adverse experiences increase the risk of depression, suicide, alcoholism, drug use, and chronic diseases.
• Child abuse, emotional abuse, and neglect are linked to adult mental disorders, suicide attempts, drug use, and risky sexual behavior.

Education and Health

• Health inequalities are not inevitable, as the magnitude of the relation (the slope of the gradient) varies between societies.
• There are significant differences in life expectancy based on education levels across European countries.
• Countries with the largest inequalities in life expectancy are generally in central and eastern Europe which have the lowest national income and average life expectancy.
• The impact of low education on life expectancy varies greatly depending on the country.
• Education fosters life skills and is correlated with better jobs, income, living conditions, and reduced stress in adult life.

Income Inequality

• What happens during working age and at later life make important contributions to health inequalities.
• Income inequality damages the health of everyone, and the lower the position in the hierarchy, the more health is damaged by living in a country with poor average health.
• Massive inequalities of income and wealth can lead to health inequalities by reducing available resources for everyone else.
• High income inequality can result in some people not having enough for a healthy life, leading to a lack of a Minimum Income for Healthy Living.
• Income inequality can lead to governments having too little to spend on essential services, reproducing private affluence and public squalor.
• High income inequality damages social cohesion and increases crime due to the increasing separation of the rich from everyone else.

Organization of Hope

• Action at local, workplace, community, national, and global levels can reduce avoidable health inequalities.
• There is sufficient evidence to act and make a difference in reducing health inequities through life course interventions.