Health professions pledge action against socioeconomic factors responsible for health inequalities

BMJ 2013; 346 doi: (Published 19 March 2013) Cite this as: BMJ 2013;346:f1814
  1. Ingrid Torjesen
  1. 1London

The medical royal colleges and other bodies representing health professionals have pledged to do more to tackle health inequalities through direct action on the social determinants of health.

The Royal College of Physicians, the Royal College of Surgeons, and the Royal College of General Practitioners are among 21 organisations to make firm commitments to act, which include investigating a patient’s social and economic circumstances as well as their medical history when assessing health.

The commitments are included in a report, Working for Health Equity: The Role of Health Professionals,1 launched on Monday by University College London’s Institute of Health Equity at a conference at the BMA in London.

In 2010 the government commissioned an independent review by Michael Marmot, the institute’s director, which confirmed that a clear social gradient existed in health outcomes and that this was related to social and economic factors.2 The review found a gap in life expectancy across England between the best off and worst off people of seven years and an even greater difference in disability free life expectancy between the best and worst off of 17 years.

The Marmot review said that most of these factors—experiences in the early years of life, education, working life, income, and living and environmental conditions—lay outside the traditional remit and reach of the health system, so its recommendations focused mainly on actions that could be taken outside the health system to reduce health inequalities.

The latest report outlines what those working in the health system could do to contribute. It says that there is much that the healthcare system could do, beyond ensuring equity of access and treatment, to influence the wider social and economic factors that influence health.

In a foreword to the report Marmot said, “Action on the social determinants of health should be a core part of heath professionals’ business, as it improves clinical outcomes, and saves money and time in the longer term. But, most persuasively, taking action to reduce health inequalities is a matter of social justice.”

The report recommends that mandatory training in the social determinants of health be included in undergraduate and postgraduate medical education and in continuing professional development. This training should encompass practice based skills, such as taking a social history, to enable better understanding of the root causes of ill health, and referral to non-medical services.

Health professionals, medical students, and healthcare organisations should act as advocates for patients, their families, and local communities to improve social and economic conditions and reduce inequalities. And professional bodies and the health system should push for policy change to act on the social determinants of health by maximising the opportunities offered by the legal duties to reduce inequalities under the Health and Social Care Act 2012 and in the Public Health Outcomes Framework.

The report also promotes the importance of working in partnership and supporting joint commissioning and data sharing to prioritise health sector action on health inequalities. And finally it calls for healthcare careers to be opened up to people from all backgrounds and for all NHS staff to be paid a minimum income for healthy living.

Doctors should take a holistic approach to managing the health of patients by considering the effects of their social, economic, and environmental circumstances, said Richard Thompson, president of the Royal College of Physicians. “We also encourage all doctors to use their powerful voice on a personal, community, national, and global level to promote action on health equity,” he said.


Cite this as: BMJ 2013;346:f1814