3.1.1. Countries enabled to address social determinants of health across the life course

The world has seen considerable health gains over the last century, but the distribution of those health gains is vastly unequal with inequalities in many health outcomes existing both within and between countries. There is increasing recognition that patterns of morbidity and mortality follow inequalities that are rooted in societal, political and economic conditions, including lower standards of housing and education, fewer employment opportunities and inadequate access to safe and healthy food and health care for certain groups. Such circumstances negatively impact health outcomes and lead to health inequities that undermine human development and impede the economic and social development of communities and countries. 

Adverse social determinants of health can form barriers to access to public health and negatively impact well-being. For example, poor urban planning, unsafe housing and mobility contribute to an increase in noncommunicable diseases, as well as in road traffic injuries and increases in violence. These conditions compound across the life course, leading to increased accumulated risk as people age for those who can afford it the least. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. 

Shifting from the narrow viewpoint of health as merely the absence of disease to an understanding that it is a manifestation of broader well-being requires governments to recognize that investment in health and the conditions that improve health is a political choice. Understanding that health is created through a combination of structural factors allows for action to be moved towards the root causes of ill- health and injury. These include income, education, occupation, social class, gender, and ethnicity as well as broader social distributions of power and resources, including through the commercial determinants of health. 

To implement action on the root causes of ill health and injury requires a multisectoral approach to developing and implementing policies that affect health across all ages. This means working with sectors that lie outside the traditional ambit of health, including transportation, urban planning, justice, education, housing, social protection, agriculture, trade, development and migration. For example, the lack of dialogue between policy-makers in the fields of social determinants of health and immigration has resulted in missed opportunities to ensure better health for migrants. 

This output is cross-cutting in its nature and involves close collaboration across efforts on related outputs across work to achieve the triple billion targets, including work on the United Nations Decade of Action on Nutrition 2016–2025 and the International Code of Marketing of Breast-Milk Substitutes; multilateral trade agreements and investment mechanisms; Codex Alimentarius and One Health approach (output 3.1.2); multisectoral action to address risk factors for noncommunicable diseases and injuries; as well as health promotion (output 3.2.1); multisectoral action to protect, promote and support health, health equity and well-being, using a life course and social determinants of health approach that starts before conception; systematic approaches to address the commercial determinants of health through engagement with the private sector and civil society, as well as strengthened regulatory frameworks and fiscal measures for health improvement (output 3.2.2); urban and commercial dimensions of environmental determinants of health and climate change (output 3.3.1); strengthened settings-based approaches including community engagement and empowerment (output 3.3.2); synergies with the work on strengthening health governance (output 1.1.4) and fiscal policies and investment cases (output 1.2.1); and addressing social determinants through work to mainstream gender, equity and human rights (output 4.2.6.). 

There is further collaboration with work on health systems, particularly improving service delivery, disease control and elimination, addressing health issues through the life course (outputs 1.1.2 and 1.1.3) and strengthening national and subnational capacities for emergency preparedness (output 2.1.2) will not be achieved without a social determinants of health perspective.