Foreword

Summary

The Commission on the Social Determinants of Health ‘Closing the gap in a generation’ was commissioned by the World Health Organization and reported in 2008.The overarching recommendations included: improving daily living conditions for all people throughout life; tackling the inequitable distribution of power, money and resources; and measuring and understanding the problem and assessing the impact of action to achieve greater health equity in a generation.

Fair society, healthy lives (The Marmot Review, 2010a, 2010b) brought together the best available evidence and proposed six key policy objectives to address the social determinants of health and reduce the health gap in England. The report is clear. The underpinning objective is to create the conditions within which individuals and communities have greater control over their lives and greater political influence. Empowerment of individuals and communities was identified as an essential part of addressing the avoidable and, therefore, unjust inequalities that drive health inequalities, poor health and health behaviours.

Extending local democracy and giving people and local communities a greater say is driven by values of equity and social justice. This requires a shift in the culture of public health and public service away from deficit models to a more citizen-focused and asset-based approach that seeks to mobilise local capacity, contribution and creativity in defining and developing local solutions to local problems.

In the current global recession, there is a danger of a narrowing of focus, with prioritisation of the most vulnerable and attempts to do this with fewer resources. Such economic difficulties are not, however, a reason for inaction on health inequalities. Investment in early years, active labour market policies, social protection, housing and place, and the mitigation of climate change provide public protection and lay the foundations for a healthier future.

Radical reform is needed to transform the way in which services are designed and provided, taking upstream approaches that are people-centred in a whole-population perspective, which complements remedial work with early intervention and prevention focused on extending the resilience, capacity and capability of local people.

This publication sets out the main issues in developing and delivering such an approach. The focus is on creating a more collaborative framework within which co-production of health and well-being is secured on a more equitable basis between individuals, communities and public health services, facilitating community action on the social determinants of health.