This backgrounder is part of a Local Democracy Research Centre paper on global health inequalities. Read Still unequal: dealing with health inequalities through the pandemic and beyond
There is a degree of consensus about how we define health inequalities among governments and local government in the UK. It is a more complex issue when looked at globally where there are differences in how health inequality/inequity are defined – and this does have an impact on the use of data and how it is interpreted and analysed. The values and the priorities behind different policy approaches are also important.
In the UK health inequalities are seen as avoidable differences in health and wellbeing across the population, and between different groups within the same population or in society generally. They come about because of the conditions in which people are born, grow, live, work and age. These conditions influence our opportunities for good health, and how we think, feel and act, and this shapes our mental health, physical health and wellbeing.
This is the World Health Organisation (WHO) definition:
Health inequities are systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies. Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age.
The WHO describe health inequalities and the social determinants of health in more detail here:
The circumstances of daily life are, in turn, shaped by political, social and economic forces that affect everyone, although not equally. This leads to a social gradient in health, in which the most disadvantaged tend to have the worst health and, in the context of Covid‑19 and its containment measures, are also the most vulnerable to further worsening of their health and of their social and economic situations.
The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.
The SDH have an important influence on health inequities – the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.
Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH account for between 30-55 per cent of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.