3.4 The Social Determinants of Health
In the introduction to the book Social Determinants of Health [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] ’ edited by Michael Marmot and Richard Wilkinson (2006), Marmot starts by pointing out the fact that in the Scottish city of Glasgow people living in the most deprived districts have a life expectancy 12 years shorter than those living the most affluent (see also WHO 2011). This gave rise to the concept of ‘The Glasgow Effect’. The idea of Glasgow as the “sick man of Europe” where people experience a reduced life expectancy plays out patterns from earlier work, life expectancy is geographically uneven, and as this article in the UK Guardian notes relates to a complex range of factors.
Broadly these are the ‘Social Determinants of Health and are often represented graphically (see Figure 3.3). Marmot, Wilkinson and a range of other academics have built up a substantial body of work around this area. Marmot's article in the Lancet from 2005 provides more detail and a global perspective and Social Determinants of Health: The Solid Facts also edited by Wilkinson and Marmot provides useful background.
A positive initiative
There are examples of programmes in various developing countries that are positively contributing in reducing the infant and maternal mortality. Click to the next activity to watch a video and explore further.
Activity 3.4
Follow this link and watch a video of the health project run by BRAC, the largest Non-Governmental Development organization (NGO) in the world, located in Bangladesh.
Think about what you observed in the video. What do you feel are the most important features of the BRAC programme? Make a note in your reflective log, of any interventions that you feel would be valuable in other contexts that you are aware of.
Discussion
As you can see in this video, despite constraints on resources and limitations on a number of levels, individuals and organisations are tackling the problem of infant mortality in innovative ways. There is much we can learn from programmes in developing countries, such as the example in this video.
3.3 Infant and maternal mortality