The development of a society, poor or rich, can be judged by its people’s health, the equity of health across the social spectrum, and how well its weakest members are protected from the disadvantages of ill health. Traditionally, society has looked to the health sector to deal with its concerns about health and disease. But many health inequities are the result of conditions in which people are born, grow, work, and age—and the consequence of failed social policies, unfair economic arrangements, and weak governance. As the global burden of disease shifts from infectious diseases to non-communicable disease challenges, many of which are influenced by drivers beyond the health sector, addressing the social determinants of health becomes imperative. Cross-sectoral collaboration across government, finance, education, housing, employment, and transport will be as essential as efforts to strengthen national health systems. Focusing on the determinants of health outside the health sector also requires prioritizing human rights, equity, and women’s empowerment.
Health and Strong Societies
Subthemes
Health & Aging
Health & Inequity
Health Systems
HEALTH & AGING
For the first time in history, most people can expect to live into their 60s and beyond. Most of the health problems of older age are the result of chronic diseases, but many can be prevented, and others can be effectively managed, provided the appropriate health services are available. Urbanization, along with advances in transportation and communication, offer both advantages and disadvantages for the well-being of older people. For some, these changes will create new opportunities, such as continued employment, but for others, they will remove social safety nets. If we are to build societies that are cohesive, inclusive and equitable, we need to ensure that the needs of an aging population are met—in fact the greatest costs to society will not be the expenditures required to meet these needs, but the benefits that will be missed if we fail to make the appropriate investments.
Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.
Resources:
2023 World Population Data Sheet
The 2023 World Population Data Sheet, published annually by the Population Research Bureau (PRB), provides the latest data on key population, health, and environment indicators for major world regions and over 200 countries and territories. This year’s data sheet has a special focus on climate vulnerability and resilience, examining indicators such as the number of projected deaths due to temperature changes, food insecurity, and the number of internally displaced persons due to disasters. The data sheet provides comprehensive data on global population trends, including birth and death rates, total fertility rates, life expectancy at birth, family planning, and more.
World Social Report 2023: Leaving No One Behind in an Ageing World
This report published by the United Nations Department of Economic and Social Affairs (UNDESA) focuses on aging, exploring the economic and social implications of an aging human population. The report highlights how globally, people are living longer than before, outlining a new set of challenges and opportunities to achieve the global Sustainable Development Goals (SDGs). The report highlights the importance of social policies and programs which reduce inequality throughout the lifespan, such as universal health care programs and social protection systems—finding that countries that implement these systems are better able to reduce income inequality and poverty at older ages.
WHO Fact Sheet: Deafness and Hearing Loss
This fact sheet from the World Health Organization (WHO) describes the magnitude and distribution of the health burden of hearing loss, as well as what can be done to prevent, manage, and treat it. Over 5 percent of the world’s population has disabling hearing loss. By 2050 over 2.5 billion are estimated to have some degree of hearing loss and 700 million will require hearing rehabilitation. Hearing loss can be due to genetic causes, complications at birth, certain infectious diseases, chronic ear infections, the use of particular drugs, exposure to excessive noise, and aging. More than one billion young people (aged between 12–35 years) are at risk of hearing loss due to exposure to noise in recreational settings.
INEQUITY & POVERTY
Social inequities in health refer to disparities that are judged to be unfair, unjust, and avoidable and that systematically influence the health of vulnerable populations. These may be generated early or late in life by differences in access to material resources, social circumstances, or health behaviors. For example, the conditions under which people work influence their health and the circumstances which promote health. There are strong linkages between health and poverty, particularly at the level of the household. Out-of-pocket payments for health services can trap families in repeated cycles of catastrophic expenditure and impoverishment—the reduction in household income may then hinder a family’s ability to provide for, nourish, and educate children. To address the social determinants of health, health professionals need to promote a common understanding of the value of health across sectors and contribute to innovative mechanisms that work across conventional policy siloes.
Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.
Resources:
Jails and Pretrial Detention: A Human Rights and Health Justice Problem
This article from Think Global Health examines the use of pretrial detention in the United States and globally, detailing how the practice undermines human rights and poses significant risks to the health, safety, and well-being of those detained. The article highlights how people in pretrial detention face inhumane conditions and violation of human rights, including lack of access or provision of adequate health care, along with jail-attributable injuries, illness, and deaths.
Homelessness and Health: Factors, Evidence, Innovations that Work, and Policy Recommendation
This overview article from Health Affairs analyzes the structural and individual risk factors that lead to homelessness in the United States, exploring the relationships between homelessness and health. The authors review evidence concerning homelessness and poor health outcomes, and discuss programmatic and policy innovations toward addressing the root causes of homelessness—namely the lack of affordable housing.
Lancet Series 2023: Global Inequity in Diabetes
This Lancet Series examines the impacts of structural racism and geographical inequity on the global diabetes crisis. The papers in this series show how structural inequities amplify and compound the upstream and downstream social determinants of health, which leads to greater prevalence of diabetes and poorer outcomes for those who experience injustice.
HEALTH SYSTEMS & DELIVERY
The majority of the world is facing a rising rate of chronic diseases (e.g., cardiovascular, diabetes, cancer, mental health disorders), risk factors (e.g., smoking, obesity), as well as intentional injuries (e.g., suicide, interpersonal violence) and accidents (e.g., road traffic injuries). Many countries that are still battling infectious diseases are now confronted with a ‘double burden’ of disease. Strong national health systems that provide equitable universal coverage, ensure access to health services, and protect against financial hardship that results from out-of-pocket health care costs have never been as important. From public health measures and population-level strategies to clinical health services spanning prevention, management, and treatment, innovation will be needed on both the ‘supply side’ (e.g., delivery of high-quality services) and the ‘demand side’ (e.g., people seeking and using the services). WHO Director General Margaret Chan asserted that universal health coverage is “the single most powerful concept that public health has to offer.” The recognition that good health is not only a consequence of economic development, but also a driver of it, calls for multi-sectoral action to make this conceptual idea a reality.
Below are examples of resources relevant to the overarching themes. Previously highlighted resources and additional resources can be found in our digital Repository.
Resources:
State Profiles for Women's Health
These state profiles from Kaiser Family Foundation (KFF) provide the most recent data and policies on women’s health in the United States. Each state profile includes data on health status, health insurance and Medicaid coverage, use of preventive services, sexual health, maternal and infant health, and abortion policies. Most of the indicators included in the profiles can be explored by race and ethnicity, and individual graphs and charts are available to download.
World Malaria Report 2023: Regional Data and Trends
These regional country profiles assess global and regional malaria trends, highlight progress toward global targets, and describe opportunities and challenges in controlling and eliminating the disease. The World Malaria Report 2023 assesses global and regional malaria trends, progress toward achieving global targets, and discusses opportunities and challenges in controlling and eliminating the disease.
State of Commitment to Universal Health Coverage: Synthesis, 2023
This report from UHC2030 assesses whether governments are meeting their commitments toward establishing universal health coverage (UHC). The report analyzes progress in countries worldwide, providing an overview of key findings, gaps, and challenges related to achieving UHC. The analysis underscores the tremendous impact of the COVID-19 pandemic on health systems worldwide—and highlights the gaps in service coverage and financial protection.
Regional Profile
Media and Body Image: Lessons from Fiji
In a world of global instant media, advertising imagery in one country can influence cultural ideals across borders, with occasional devastating effects on health. When Harvard anthropologist and psychiatrist, Dr. Anne Becker, suspected television as the culprit in a spike of eating disorder symptoms among girls in Fiji, she conducted targeted research to understand why this was happening and what to do about the problem. Eating disorders can lead to malnutrition, heart disease, and organ complications, and they are associated with depression and low self-esteem that can lead to suicidal tendencies. Treatment requires mental health intervention, a rare resource in poor countries. Becker found that girls were most influenced by their peers’ exposure to mass media, but education could help. Effective responses call for engaging parents to raise awareness, training teachers so they can help identify students at risk, and political activism to change policies. Learn More.
Population Snapshot
Imprisonment and Social Disparities in the U.S.
The rate of imprisonment in the United States more than quadrupled during the last four decades. With nearly 1 out of every 100 adults in prison or jail, the rate is 5 to 10 times higher than those in Western Europe and other democracies. With just under one-quarter of the world's prisoners held in American prisons, the U.S. prison population of 2.2 million adults is now by far the largest in the world. Perhaps most disturbing is the disproportionate representation of men under age 40 and minorities, and the prevalence of drug and alcohol addictions, mental and physical illnesses, and lack of work preparation. A recent landmark National Research Council Report analyzes the historically unprecedented rise in the use of incarceration in the U.S. and the consequences for the people imprisoned, their families and communities, and for U.S. society. Learn More.
Sector Perspective
Design, Health and the Drinking Fountain
When London’s first public drinking fountain opened in 1859, thousands of people came out to celebrate the installation. Before then, access to clean water in London was nearly impossible for poorer classes, leading to the rampant spread of waterborne diseases like cholera. Shortly after the father of modern epidemiology, John Snow, discovered the role of water in the spread of cholera, London philanthropists spearheaded the construction of hundreds of water fountains. Their design still posed one problem: Most fountains used common cups, which also spread disease. Want to know what happens next? In this episode of the radio show 99% Invisible, host Roman Mars dives deep into the history and design of the now ubiquitous water fountain, also tracking its connections to public health, the temperance movement, and even segregation. Learn More.
Featured
Emerging Models of Education
This essay examines how emerging models of education in medicine, public health, and engineering are evolving to reflect the needs for an increasingly globalized world. While public health education is increasingly accommodating scholars who come from a diversity of backgrounds, engineering education is incorporating real-world challenges that not only focus on the core concepts but the applications of the concepts in complex environments. After all, resource-poor and rich countries are challenged by a similar set of problems—both need health systems that emphasize access, coverage, quality, and affordability. Arguing that we need to rethink the way in which we train health sector professionals, the authors suggest that the contemporary graduate is one who “understands systems beyond the individual organ; understands disease and cure in context; and has developed the knowledge, skills, and tools to innovate, seeing the global context as a resource for understanding and ideas rather than as developing countries in need.” Learn More.