In all countries, from the richest to the poorest, there is a division of social classes through a hierarchy created according to the distribution of income, education and power, among other resources.
The combination of these conditions and their interdependence affect multiple aspects of our existence, especially health, which is why they are called the social determinants of health. The World Health Organization defines them as the conditions in which we were born, raised and lived in. We learn, work, play and grow old. They are independent factors of medical care that greatly influence health and are influenced by social decisions and policies.
The University of Wisconsin produces an annual report on the municipal health classification in the USA and the model developed there gives the following relative weight on the health of the population for each of the many factors: socioeconomic status – 40%; Lifestyles – 30%; Clinical care – 20%; Physical environment – 10%.
The most disadvantaged and vulnerable social groups are most likely to suffer from obesity, depression, diabetes, cardiovascular disease and respiratory disease. The most influential social determinants are the level of education, economic stability, social and societal context, housing, neighborhood and food.
For more than a year, covid-19 has become the biggest challenge to populations and health services worldwide. No social stratum is excluded, but in this case as well, there are disparities that are directly related to social hierarchies. Poor groups and societies, with lower educational levels and poor living conditions, including housing, are more vulnerable to infections, more serious diseases, more severe development, and higher mortality.
The economic crisis caused by the Covid-19 virus will drag up to one billion people into poverty and many more will see their incomes affected in some way due to the variable, but inevitable, decline in the revenues of various countries. As a result, many social determinants, namely employment, housing, education, food, health care, and wages will deteriorate.
A study published by the Manuel dos Santos Foundation now indicates that in 2019, even before Covid-19, 1.6 million Portuguese were at risk of poverty, despite the fact that a third of them had jobs without risk. The pandemic will exacerbate our national poverty scenario.
The effects of this worrying context will increase the differences and disparities in the health status of citizens, with the obvious harm to the elderly, the most deprived and those with the fewest resources.
Governments and other global authorities should pay the most attention to these matters, not least because, as we have already seen, clinical care is responsible for only a fifth of the health and well-being of a population.
Health is a political choice and its social determinants can, in this way, be balanced, and affect either positive or negatively the equity in health.
Given that the contribution of sectors “outside health” exceeds that of their specific sector, we must agree that “everything is healthy” and that public funding not only must be diversified, but also be based on results, not costs. .
The author writes according to the new spelling agreement