Intended for healthcare professionals


Ensuring the health of future populations

BMJ 2012; 345 doi: (Published 12 November 2012) Cite this as: BMJ 2012;345:e7573
  1. Hilary Graham, professor of health science
  1. 1Department of Health Sciences, University of York, York YO10 5DD, UK
  1. hilary.graham{at}

Requires that social determinants are set within the wider biophysical environment

Marmot’s recently published review of health in Europe identifies people’s social and economic conditions as fundamental determinants of their heath.1 Like the larger World Health Organization report on which it builds,2 the report singles out conditions in early life and urges governments to give priority to improving children’s lives to promote both their future health and the health of future generations. The social determinants of health and a commitment to intergenerational equity are the cornerstones of the review.

The review’s concern with social determinants and generational equity aligns it with the broader mission of public health. In its classic formulation, the role of public health is to ensure the conditions in which people can live healthy lives, and its duty is to protect conditions for health over time and across generations.3 4 The principle of moral equality—that no one individual or group is intrinsically superior to another—underpins this duty. This principle demands that “we treat the welfare of future generations on a par with our own” and do not discriminate …

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