Improving Health

Social Determinants and Personal Choice

The personal health choices available to individuals are constrained or enabled by social contexts.

Globally, the United States ranks poorly on important measures of health, such as infant mortality (25th) and life expectancy (23rd). Within the United States, great disparities exist in health by socioeconomic position.

According to the Robert Wood Johnson Foundation's (RWJF) Commission to Build a Healthier America, the health of Americans can be improved only by actions taken outside of the health care system. The environments in which people live, work, learn and play need to be changed for all Americans to enjoy good health.

Drawing on their experiences on the World Health Organization’s Commission on Social Determinants of Health and their application of findings to health inequalities in England as documented in “Fair Society, Healthy Lives,” these authors favor structural drivers of health inequity over personal responsibility. They identify three major areas of differences in their recommendations compared with that of the RWJF Commission. They express the beliefs that:

  1. Health inequities are driven by more than income inequalities.
  2. Work hazards, unemployment and job insecurity influence health inequities in addition to educational achievement.
  3. While advocating universal health care, they feel that additional special efforts need to be aimed at those in greatest need.

Reducing social and economic inequality in the United States is central to improving individual health.

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