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Healthy lives for people in the UK: Introducing the Health Foundation’s healthy lives strategy

People’s health is influenced by political, social, economic, environmental and cultural factors. These factors shape the conditions in which we are born, grow, live, work and age. They are affected by the distribution of power, money and resources across society.

Although at lower income levels the health of a population is related to GDP, above a certain threshold this relationship becomes a lot more complex. This tells us that health is not just about wealth. For example, the US has a lower life expectancy at birth than less wealthy countries including France, Sweden, Spain, the UK and Japan. Furthermore, the US spends more on health care than the UK, yet has higher prevalence of conditions such as heart disease, diabetes and cancer.

The social determinants model is important because it seeks to identify the ‘causes of the causes’* – for example, the inequality in social and economic conditions that may explain a child developing asthma due to poor housing conditions and lack of access to green space, or the psychosocial effects of a low-paid, temporary job on a worker’s risk of experiencing chronic stress and developing cardiovascular disease. These conditions are largely, or completely, outside of an individual’s control.

Unequal distribution of social determinants contributes to disparities in health – for example, in Scotland life expectancy at birth is usually higher in the least deprived council areas compared to the most deprived council areas (as measured by the Scottish Index of Multiple Deprivation).

Work on the social determinants of health has been underway for decades; however, recent publications such as the 2008 WHO Closing the gap in a generation report and the 2010 Marmot Review have contributed to their increasing recognition. In England, over 70% of local authorities are now working towards implementing the Marmot review’s six policy recommendations.