Review/2005/5

The best resource I discovered in 2003 was the World Health Organizations publication, The Social Determinants of Health: the Solid Facts second edition, by Michael Marmot and Richard Wilkinson. The second edition builds on the work of the first edition. The publication examines the social gradient in health in developed countries and explains how psychological and social influences impact on physical health, quality of life and longevity. It further strengthens the debate about the important role public policies play in the improvement of health in the population. Solid Facts outlines specific policy measures which can be implemented at various levels of governments on each of the ten social determinants of health which are discussed. For example, under social exclusion, one of the policy measures, is that all citizens should be protected by minimum income guarantees, minimum wages legislation and access to services (p.17). Solid Facts discusses and presents up-to-date and new evidence which has emerged since the first edition published in 1998.

The social determinants discussed in the publication are as follow: The social gradient, Stress, Early life, Social exclusion, Work, Unemployment, Social support, Addiction, Food and Transportation. While the evidence on the determinants presented is based on research from developed countries, several of these determinants listed are similar to determinants which countries in the English Speaking Caribbean are also trying to grapple

In addition, with the exception of unemployment, some aspects of the other eight social determinants of health are relevant to the British Virgin Islands.

I find the sold facts booklet a good resource since it attempts to simplify a complex subject in a language which can be understood by professionals form a variety of backgrounds. It provides useful references if additional information is required.

While there is mounting evidence which supports the growing acceptance that health is determined by more than behavioral, biological and genetic factors, there is still strong resistance by many health and other professionals, in key sectors such as agriculture, housing, education, labour and tourism for instance, to link economic, environmental and social factors to poor health. Hence, efforts to improve health are still very commonly confined to developing interventions targeting individual lifestyle issues or programs primary with a biomedical focus.

For health promotion practitioners who advocating for the following :

more investment of resources in upstream interventions;
or other sectors to be aware of the health implications of their actions on the population;
health to be conceptualized as a developmental issues;

it is often difficult to find sound scientific evidence to substantiate ones argument. Hence the Solid Facts is a welcome resource. It is also difficult at time to find concise user- friendly resources on the social determinants of health to share with those that one is trying to influence. I find this publication a good resource for public health professionals as well as professionals in other sectors (including policy analysts and policy makers), who need to engage in the debate on social determinants of health, especially at a national level.

I am using this publication in my work to help raise awareness of the social determinants of health among colleagues, to guide my work in policy development. I am also using The Social Determinants of Health: the Solid Facts to advocate for the establishment of needed infrastructure that will support intersectorial collaboration and community actions to improve population health and well being of the people of the British Virgin Islands.