Health equity (social determinants)

The most important determinant of whether a person leads a “healthy long life” is not good access to healthcare services or lifestyle issues, but where a person sits on the social scale.

The lower a person’s social position, the worse his or her health and the more likely they are to die prematurely. 

The NSMC provided technical input to the Marmot Review of the Social Determinants of Health, and worked with the Department of Health (England) and UCL's Institute of Health Equity to identify ways in which social marketing can be used to address the social determinants of health (SDH). 

What are the social determinants of health?

Our health is not only shaped by our access to quality health care, but also by the social and physical environment. According to the WHO the social determinants of health are “the conditions in which people are born, grow, live, work and age, including the health system”.

The Marmot Review was set up by the Secretary of State for Health to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. 

One of its most startling findings was that many people who are currently dying prematurely each year as a result of health inequalities in England would otherwise have enjoyed in total between 1.3 and 2.5 million extra years of life.

The Review concluded that the most important determinant as to whether a person leads a “healthy long life” is not good access to healthcare services or lifestyle issues, but where a person sits on the social gradient. The lower a person’s social position, the worse his or her health, and the more likely they are to die prematurely. 

Inequalities in early childhood and education, employment and working conditions, housing and neighbourhood conditions, and standards of living all relate strongly to health. Action is needed across all of these social determinants of health by central and local government departments as well as the third and private sectors.

The Review recommended that reducing health inequalities requires action on six cross-cutting policy objectives. These are:

  • Every child has the best start in life
  • All people can maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure a healthy standard of living for all
  • Create healthy and sustainable places and communities
  • Strengthen the role and impact of ill-heath prevention

How can social marketing help health equity?

Social marketing can provide some useful lessons for policy makers aiming to address the social determinants of health. Find out more about social  marketing.

Social marketing can help to focus on the specific priority behaviours we can realistically influence today while also mobilizing public demand for the environmental changes that are needed to influence the wider social determinants of health.

Social marketing programmes have a greater chance of sustained success if they take a 2-pronged approach to try and influence the internal (psychological) and external (environmental) factors that influence how we behave.  For example, any programmes designed to motivate responsible alcohol consumption must also address key environmental factors such as accessibility, price and the intensive marketing of competing products.

Social marketing can help to make the most cost-effective use of limited public resources by:

  1. Utilizing existing strengths, resources and opportunities from within communities
  2. Pre-testing effective approaches at a local scale
  3. Taking preventative action to address emerging social problems

Social marketing can provide government agencies, NGOs and the private sector with a transparent platform for working together because it is clearly based on providing evidence of sustained behaviour change as the bottom-line indicator of success.

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Health equity case studies

The case examples included in this demonstrate how government agencies and NGO’s have applied social marketing to successfully increase the adoption of healthy behaviours such as stopping smoking, getting a breast exam, or eating more fruit and vegetables. Other examples look at how social marketing can be used to address important social issues such as crime, problem gambling, unemployment and road safety.  All of these cases also demonstrate practical and cost-effective attempts to change the social and environmental contexts that shape many of our, often unconscious and habitual, behaviours.

Training

The NSMC has trained over 10,000 people in social marketing. Find out about our world-class social marketing training and e-learning.

Improving effectiveness...

The NSMC continues to play an important role in improving the effectiveness of governments' and national organisations' behaviour change programmes.

Mary Newman, Head of clinical strategies, Department of Health