Introduction
Report rationale, background and structure
The report is structured as follows:
This report builds on the 2010 report Fair Society Healthy Lives (The Marmot Review) (2), the World Health Organisation’s 2008 Commission on the Social Determinants of Health (3) (CSDH) and the 2013 WHO European Review of Social Determinants and the Health Divide (29). These reports compiled the best available evidence about the factors, in other words the conditions of daily life, which shape health. Most of these factors lie outside the immediate reach of the health system – in early-years experiences, education, working life, income, and environment and living conditions. The reports made recommendations on how best to reduce health inequalities, which were mostly focussed on actions which could be taken by those working outside the health care system. This report now focuses on actions and strategies that can be developed by health professionals in their roles in the health care system. Those in the health sector regularly bear witness to, and must deal with, the effects of the social determinants of health on people. This report will demonstrate that the health care system and those working within it have an important and often under-utilised role in reducing health inequalities through action on the social determinants of health. The report explores literature, case studies, and other evidence that shows how health professionals can influence social determinants and tackle health inequalities in a systematic and effective way. The health workforce are, after all, well placed to initiate and develop services that take into account and attempt to improve the wider social context for patients and staff. The report sets out a series of commitments by health professionals and other organisations to embed and develop action on the social determinants, and these form the basis for an ongoing programme of work led by the Institute of Health Equity in partnership with Royal Colleges, the Academy of Medical Royal Colleges (AoMRC), the British Medical Association (BMA), the Canadian Medical Association (CMA), the World Medical Association (WMA), and other organisations and institutions. These commitments will extend and develop over time, but are included in their current form throughout the document at the ends of chapters, in order to give an indication of future steps.
Part A – Health professionals: Ways to take action on health inequalities
1 Workforce education and training Here we discuss ways to embed an awareness of and ability to affect social determinants of health in the future workforce through development of the curriculum, placements, and Continued Professional Development. We also discuss the issue of more equal access to health education. 2 Working with individuals and communities We set out practical ways for health professionals to improve the social determinants of health of their patients and related to that, propose ways to gather information on the impact of social and economic conditions on people’s health. 3 NHS organisations The role of the NHS as an employer is assessed, and actions are proposed to improve health outcomes and reduce health inequalities of the approximately 1.4 million NHS staff. This includes management practices and specific strategies to improve health along the social class gradient. 4 Working in partnership We discuss the important issue of partnerships and co-working, both within the NHS and with external partners such as social workers and local authorities. This includes the role of Clinical Commissioning Group (CCGs), and the importance of cross-organisational partnership and community involvement. 5 Workforce as advocates We outline the potential of individual health professionals and professional groups such as Royal Colleges and unions to act as advocates for individuals, for communities, for the health professional workforce, and for the whole population through policy change. 6 The health system – challenges and opportunities We discuss some mechanisms within the health system that can be used to leverage change and increase action on the social determinants of health, and also discuss other mechanisms that may prove obstructive or unhelpful.