The social determinants of health have been described as “the causes of the causes” of illness. They affect people’s health and well-being in the environment into which “they are born, grow up, live, work and age.”
Key behavioural pathways leading to NCDs and jeopardizing the achievement of SDG3.4 have long been identified, and frequently the focus in NCD prevention has been on improving diet, reducing smoking prevalence and harmful use of alcohol, and increasing physical activity, as well as managing conditions following diagnosis. Much of this work is within the remit of public health and health professionals. However, as low- and middle-income countries strive to address NCDs as a major threat to sustainable development, a social determinants approach is increasingly highlighted as one of the important focus areas due to its relevance to all sectors.
Social determinants of NCDs include: socio-economic context; inequality; level of education; gender; ethnicity; social norms; cultural beliefs and practices; social exclusion; income; employment; access to health services; transportation; social and community support networks, including social cohesion. In addition, public policies (policy coherence) and the economic and political structures and accompanying ideologies shape the adverse circumstances negatively influencing health.
Therefore, the social determinants of health need to be addressed through the whole-of-society and whole-of-government approach to improve the health outcomes and health equity across different population groups.
Addressing the social determinants of NCDs can be accomplished through using analysis of the determinants in shaping interventions across the life course in order to enable children, young adults and elderly to live up to their full potential and have control over their lives. Interventions may include poverty-reduction strategies, social protection measures, community engagement, including addressing social norms and cultural beliefs, and tailored health promotion approaches. Furthermore, social determinants of health underpin the implementation of all SDGs due to their interlinked nature and the need for policy coherence and intersectoral interventions, most of which fall outside the health sector. However, the health sector, an important social determinant itself, also has an important role within the Health in All Policies, whole-of-government and whole-of-society frameworks to act as a facilitator of policy development and coordination across sectors and stakeholders. Hence, the social determinants approach is central to achieving not only SDG targets, including SDG 3.4 on the one third reduction of premature mortality from NCDs, but other related targets as well, such as SDG 3.8 on enhancing universal health coverage.