Commentary: Social determinants and the health gap: creating a social movement

Before the WHO Commission on Social Determinants of Health (CSDH) had its meeting in Kobe in 2008, we met the Japanese Prime Minister and other senior government people. One said: ‘We used to think that global health was about disease control; we now recognize that it should also embrace heath systems’—hence universal health coverage. I said that the mission of the CSDH was to offer a third approach, complementary to the first two: action on the social determinants of health, vital for achieving health equity. To put this third approach on the agenda, I said at the outset of the CSDH (I was the chair) that we wanted to create a social movement, using the best evidence on improving society to advance health equity. I was not at all sure what a social movement looked like, but the signs are promising. For the CSDH, we convened nine knowledge networks involving hundreds of scientists and experts, we engaged with civil society, we talked to governments. Many of these people have become advocates for social determinants of health. They, and many others, are part of our social movement. In Sweden, for example, a parliamentarian said to me publicly in 2013: ‘Commission reports have a half-life of about six weeks; your report is still being discussed in the Swedish Parliament five years after publication’. That parliamentary discussion led to the setting up of a National Commission under the chairmanship of Olle Lundberg— the author of one of the commentaries here. I am told that there are ten ‘Marmot Reviews’ being conducted in different geographical areas of Sweden. Sweden is not alone. In England, I was commissioned by the government to conduct a review of social determinants of health and health inequalities which was published in 2010 as the Marmot Review, Fair Society Healthy Lives. Further, commissioned by Szuszanna Jakab, WHO Regional Director for Europe, I led a European Review of Social Determinants and the Health Divide. There has been action in many countries. A further marker of our social movement: in the ten months after we published the English Marmot Review, Fair Society Healthy Lives, in 2010, my colleagues and I gave approximately 190 invited talks in the UK and globally. There was, and still is, a huge thirst for our approach to reducing health inequalities and promoting health equity, through action on the social determinants of health. It was to capture the knowledge that was synthesized in these reviews, and evidence of what happened since, that I was prompted to write The Health Gap: The Challenge of an Unequal World. I want the third approach, social determinants of health, on the agenda, and want somewhere that policy makers, students and, dare I hope, interested non-experts can find insights into it. When an ear nose and throat surgeon comes to me, as happened recently, and asks humbly if I will sign five copies of The Health Gap because he wants his younger colleagues to read it, as he has, it is a marker that my ambition for the book is being fulfilled. My consistent message is social justice and evidencebased policies as I seek to engage government and others in action on social determinants of health. A commitment to social justice is important but so too is the evidence. Hence The Health Gap drew on the evidence provided, in addition to the CSDH, by the nine groups of experts we International Journal of Epidemiology, 2017, Vol. 46, No. 4 1335