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The Social Determination of Health


The conditions which shape our health lie before and beyond the technologies of health care. This has been appreciated in many different ways in many different cultures for millenia.

In the European tradition Rudolf Virchow epitomises the commitment of health practitioners to address the social determinants of health through research, advocacy and politics.

This commitment was embedded in the 1978 Declaration of Alma-Ata which affirms the responsibility of health practitioners to work with their communities to identify and address the determinants of health which lie outside the direct reach of health care. This aspect of the Declaration is too often overlooked.

The focus of WHO moved away from PHC and the Social Determinants of Health under the leadership of Dr Nakajima and Dr Gro Harlem Brundtland. Indeed under Brundtland WHO moved to cooperate closely to the World Bank. The WHO Commission on Macroeconomics and Health (2001) reflects this trend most clearly.

Learning objectives

This topic has been prepared to enable participants to:

  • identify the full range of social and environmental determinants which affect the health of the communities they are working with;
  • be broadly familiar with the evidence regarding the pathways and mechanisms through which social determinants shape the health chances of communities;
  • be familiar with the political and economic dynamics, from national to global, which reproduce health damaging environments;
  • be familiar with the principles of comprehensive primary health care and the dynamics and pathways through which PHC can support action on the social and environmental determinants of health;
  • be familiar with the broad range of strategies which may be used to address the social and environmental determinants of health;
  • be skilled in planning campaigns and other initiatives which will help to address the social and environmental determinants of health.

The WHO Commission on the Social Determinants of Health

Under the late Dr Lee the WHO moved back to a recognition of the social factors which shape health and in 2005 appointed a distinguished panel of experts to the Commission on the Social Determinants of Health.

The Commission's approach to its brief

The CSDH has produced a great deal of very useful material on the SDH. Several presentations at the June 2007 IUHPE Conference summarise some important aspects of the SDH and the Commission's work.

Overview of Social Determinants of Health by Sir Michael Marmot, Chair of CSDH

Overview of 2007 Interim Statement by the Commission by Sir Michael Marmot

Interim Statement of Commission 2007

Statement by WHO on what it expects from the Commission

Civil Society response to the Interim Statement, presented by Dr Amit Sen Gupta of the PHM

Final Reports of the seven knowledge networks set up by the Commission to assemble and synthesise knowledge in key areas, including:


The Social Determinants of Health (Hani Serag, Savar, Nov 2007)

Further topics

  • Food
  • Difference
  • Meaning and spirit
  • Discussion Questions

    What are the strengths of the CSDH approach and what does it leave out?

    What can PHM do to build on the momentum created by the CSDH?