The social determinants of health: why should we care?

Abstract

A growing body of empirical research examines the effects of the so-called "social determinants of health" (SDH) on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the (un)fairness of particular health inequalities; and second, the policy recommendations issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended-such as improving people's living conditions and reducing inequalities in wealth and power-are justified in their own right, the way these recommendations are tied to health is problematic.

Keywords: fairness; health equity; health inequality; health policy; social determinants of health.