The socio-economic inequalities in health is today the most important public health problem. What is the possible role of doctors.
We define “ determinants of health ” factors to varying degrees, are able to influence the state of health of individuals and communities: strictly biological factors (sex, age , genetic), behavioral, relational and affective, related to the environment of life and work (employment, income, social class, education, health services) and the more general context of cultural, social, economic and environmental. Factors to create a chain of causes (“the causes of the causes”) in the genesis of a disease: from more general causes (eg the socio-economic status) to the more specific (eg, behavior harmful to health).
The growing socio-economic inequalities are producing increasing and unacceptable inequalities in health and health care, among different population groups, of which we have discussed several times in this blog (read here, here and here ).
Inequalities in health are now the most important public health problem. In all of the countries of the European Union (EU-25) deaths attributable to disparities in education (which also reflect the socioeconomic disparities) are all 707,000 ‘ year, about 140 per hundred thousand people per year . In Tuscany, the impact of inequality was estimated at about 70-110 deaths per hundred thousand people per year attributable to the difference in level of education.
Nevertheless, the sensitivity and the commitment of politicians and administrators to this problem are almost irrelevant. Not to mention that the medical world – in almost all – is always anchored to a purely biological origin of diseases.
For this very striking a document produced by the leading British medical associations (including the Royal College of Physicians and the Royal College of General Practitioners ) with the title: “ How doctors can close the gap. Tackling the social determinants of health through culture change, advocacy and education . “(” How doctors can reduce inequalities in health. Addressing the social determinants of health through culture change, the defense of weaker and training “). (To download click here).
The following excerpts from the document.
Many doctors remain completely focused on clinical interventions, while all professionals should adopt a health perspective that looks beyond the immediate needs of individual patients and works to actively promote the health and well-being.
To do this it is necessary to bring about change ) in the attitudes of doctors towards the determinants of health, b) in health care and in the social system, and c) in the training of physicians.
CHANGE THE PERSPECTIVE ( Changing perspectives )
To effectively address the determinants of health requires a holistic approach to the problems, not only with the doctors who are promoting health and disease prevention, but combine with all other sectors of society to develop solutions to reduce inequalities.
There needs to be a higher level of cohesion among professionals engaged in different fields of health care, in order to deal with the social determinants of health in a more effective and more focused. A better interaction between the teams that deal with public health and clinical researchers, social workers and local administrators, and a better flow of information between these groups, will help to determine which initiatives are most effective health promotion and which population groups are less served and protected. The sharing of information on best practices on how to tackle the social determinants of health should be encouraged and centralized.
And ‘generally acknowledged that doctors are among the most respected professionals in society and this benevolence should be channeled into programs that address inequalities in health. You have that physicians at all levels from joining forces striving for equity in health by medical students to the most powerful deans of faculties of medicine. The entire medical profession can use its influential voice, both at the personal and local or national level, to promote action on the social determinants of health.
CHANGE SYSTEMS ( Changing systems )
The key challenge to address inequalities in health is represented by the fact that the most disadvantaged and marginalized in society are often the last to seek medical help. This stems from mental or physical impediments, logistical problems, language barriers or even fatalistic attitude towards health and consider the disease as inevitable. All health professionals should engage with their local communities and work to expand access to services and to connect with the population groups most difficult to reach. Health programs should be designed to give users more power and more opportunity to increase control over their health. And ‘vital to provide socially disadvantaged groups, and in particular young people, friendly and accessible information on health issues. These types of programs should proceed with a general restructuring of primary care services that provide for their strong integration with social services, educational and employment services.
The medical examination must be an opportunity to learn about the social problems of patients and identify areas of need that may require the support of non-health sectors.
CHANGE EDUCATION ( Changing education )
We must give students graduate in medicine and to the encouragement and support to be interested in the social determinants of health and promote health among the population, rather than focusing only on the care of individual patients.
It ‘important to convince students already in the early stages of their careers to learn that studies the social determinants of health will help to really improve the health of society.
The public health problems related inequalities in health and the social determinants of health should be included in all parts of the curriculum of studies and practical training.
The current public health courses are often dry and uninteresting and need to be modified to attract students ‘attention on the problems of inequalities in health. E’ recognized that the context in which we learn is as important as the content of learning, which is why students should be offered the opportunity to gain experience in the social sphere, in contact with social workers, community groups, voluntary organizations.
The training on the social determinants of health should also be included in the clinical disciplines, where the discussion about the causes of a disease should take account of the patient’s family, his life and work environment. For example when studying respiratory diseases, students should know how the social-family context can influence the smoking habits of the patients, and what could be the measures to reduce this impact. While in the hospital the discussion of clinical cases should include the socio-cultural perspective.
PS. Impertinent question. If the British medical associations themselves these problems, because it puts them if the PD?
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