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How non-health charities can help address the social determinants: report

Though not directly in the business of health advocacy, non-government organisations working in sectors such as housing, education and with those living in poverty have a key role in tackling some of the root causes of wellbeing, according to a new report published in the UK.

The Keeping Us Well report, issued by the NPC charity thinktank in conjunction with Sir Michael Marmot’s Institute of Health Equity and The Health Foundation, aims to equip non-health NGOs with the tools to link their work to the social determinants of health and its evidence base.

The authors said they hoped the report would encourage:

  • non-health charities to demonstrate and promote that their work impacts on health, and gain recognition for this
  • the health sector to recognise this role and look for opportunities to collaborate with non-health groups
  • policymakers to recognise and review the existing evidence on SDOH and consider how the NGO sector can work to reduce health inequalities

In a foreword to the report, which was underpinned by a review by the IHE, Marmot described “unjust and unfair” health inequalities arising from disparity in the “social, economic, political, cultural and environmental conditions in which people live”:

Action is needed to address these inequalities in health and well-being that affect almost all of us. Health care is important, especially when people get sick, but health is as much about keeping people well, or preventing ill health, as it is about treating them.

Our family life, friends and neighbours, education and work life, our resources and where we live, all play an integral part in determining how well we are. To improve life expectancy and healthy life expectancy across the social gradient it is essential to focus on the social determinants of health.

Marmot said the not-for-profit sector played a fundamental role in supporting families and communities, promoting education and good work, and ensuring our surroundings promoted good health.

“When non-health charities take action on the determinants of health they are working in the cause of social justice,” he said.

“Highlighting and developing the voluntary sector’s action on the determinants of health has the potential to create further impetus to an important movement, one that must now gain momentum if we are all to live longer, healthier, lives.

The report breaks down evidence, opportunities and challenges across seven major determinants of health: family, friends & communities, housing, education and skills, work, money & resources, and our surroundings.

sdohtreeWhile between 10% and 43% of health was estimated to relate to health care access, the report said the rest of these factors accounted for the vast majority of wellbeing, with persistent social and economic inequalities causing stress and hopelessness for those at the bottom of the social gradient, eroding their health.

Those living in the least deprived areas of the UK lived 16.5 years longer in good health than counterparts in the most deprived areas, with shorter and less healthy lives a direct consequence of postcode, it explained.

NGOs supported some of society’s most economically disadvantaged or marginalised groups — those most profoundly affected by the health gap — and tended to provide a more holistic view of wellbeing through their services, meaning they were well placed to tackle the SDOH, the report added.

In fact, health could be seen as an enabler of the social factors these groups worked to address, not just the inverse, meaning health could be seen as part and parcel of the not-for-profit mission, it said.

Some of the key evidence highlighted by the report included:

  • people experiencing six or more adverse childhood events are three times more likely to develop lung cancer and have symptoms around 13 years earlier, due to increased smoking risk
  • social isolation and loneliness are associated with a 50% excess risk of coronary heart disease, similar to the excess risk associated with work-related stress
  • the longer someone is unemployed, the larger the impacts on their health
  • cold housing contributed to an extra 24,300 winter deaths in 2015-16
  • access to good quality green space is associated with improved health outcomes
  • heat-related mortality is expected to range from a 70% increase in the 2020s to a 540% increase in the 2080s
  • in the most deprived quartile rates of fatal or serious road injury are nine times higher for 5 to 9-year-olds than the national average and 3.7 times higher for 10 to 14-year-olds

Worth a look, especially for those of you in the NGO, non-health space. Let us know your thoughts!

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