On the 19th May, the Universitat Pompeu Fabra (UPF) hosted the 2023 Presentation of the International Journal of Social Determinants of Health and Health Services (IJSDOHS). The event brought together experts in the social determinants of health (SDOH) from across the world to explore and discuss the major questions and future pathways for research, policy and action regarding the SDOH and health services. 

The following article summarises the key issues and discussions that proceeded in Session 1 of the event.

Session 1, entitled “What do the social determinants of health (SDOH) contribute to health equity policies?”, was moderated by Joan Benach and included presentations by Sir Michael Marmot (University College London Institute of Health Equity, UK) and Asa Cristina Laurell (Independent researcher, Mexico). 

Sir Marmot outlined three core challenges for health equity policymaking in his presentation, focusing broadly on the UK context: intergenerational equity, action on the social determinants of health and rediscovering public purpose. Regarding the first, he highlighted the issue of low social mobility and its impact on intergenerational health inequalities: “There is a complete fracturing of the American Dream, inasmuch as that wellbeing and life expectations are worse for younger generations than what they have been for older generations. This gap is exacerbated with phenomena like climate change.” Regarding the second challenge, he noted the regressive tendencies in public spending in multiple dimensions of life (for example, housing, education and health) and the negative impact this has had on health for the poorest sectors of society. Regarding the third, he criticised the neoliberal free-market ideology: “The neoliberal agenda means that people have been committed to leave everything to the market… We need a totally different approach that rediscovers public purpose. Leaving everything to the market is not going to solve the problems of climate crisis, health inequity, social injustice”.

Laurell, whose presentation drew on her experience working as a health secretary for the Mexican government, focused on the need for a paradigm shift in the way health is perceived in order to move towards greater health equity. She argued that “the medical model is very dominant, prioritising drugs and hospitalisation, while health prevention and promotion is perceived as a different space of human activity.” A more social and structural approach is needed, which takes into account the SDOH and focuses on ways to promote health at the social level, such as reducing inequalities and investing in health education. Laurell claimed that this approach to health, and the concept of health as a public good, should become the common sense: “We need to emphasise health in the political discourse and shift the interpretation of health.” Research into the SDOH helps to move towards this paradigm shift by providing evidence of how structural matters affect population health.

During the question and answer (Q&A) session that followed, the speakers engaged in discussions on issues such as populism, transdisciplinarity in research and action, democracy and the role of the state in relation to the SDOH and health inequalities. Both speakers reaffirmed the need to increase public spending and social investments in order to reduce health inequalities, and the need to include the SDOH in political and social discussions on health. In connection with these debates, moderator Benach stated the importance of transdisciplinary analysis, pointing out that the term is often used rhetorically, and in other cases the transdisciplinarity is underdeveloped.

The full video of this session can be found here.