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Figure 15 Summary pathway and mechanism of social determinants of
health inequalities
SOCIOECONOMIC
& POLITICAL
CONTEXT
Governance
Policy
Macroeconomic
Social
Health
Culture and
societal norms
and values
SOCIAL POSITION
Education
Occopation
Income
Gender
Ethnicity/Race
SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES
Material
circumstances
Social cohesion
Psychosocial
factors
Behaviours
Biological factors
Health Care System
Source: Commission on the Social Determinants of Health (2007)
DISTRIBUTION
OF HEALTH AND
WELL-BEING
The differences in social, economic and environmental conditions create a social
and health gradient, with poorer people having poorer health than more
affluent people.
Health, food and eating habits
A healthy diet is one that maintains or improves health. Healthy diets with less
animal and dairy products and more fish from sustainable sources, seasonal,
field-grown and locally produced fruits and vegetables also have a lower impact
on the environment. There is a clear social gradient in eating habits, with more
affluent people being more likely to have healthier diets (UK Food Standards
Agency 2007).
Our eating habits are influenced by, and influence, the food system. Our food
choices are influenced by availability and price, attractiveness and marketing,
and by personal, cultural and societal norms and values.
The way food is produced and consumed – combined with low levels of physical
activity – has fuelled a global epidemic of chronic diseases, particularly in the
developed world.
Emerging practices
fostering more sustainable
health and societies
• Policy makers and
professionals are
beginning to develop
common approaches and
interventions to support
healthier and sustainable
lifestyles.
• Health and equity are
becoming understood
as integral parts of all
measures and initiatives
relating to climate change
and sustainability; this
includes integrated,
multi-sectoral
approaches to health,
agriculture, education,
finance, urban planning,
social affairs and welfare,
trade and transport
sectors.
Unsustainable patterns in
health and society:
• Diet- and lifestyle-related
health problems are
increasing in EU societies.
• Higher income groups
often lead to lifestyles
that have a higher impact
on the environment.
• Lower income groups are
often more exposed and
vulnerable to health risks,
such as noise, traffic and
an unhealthy diet, than
higher income groups.
Obesity on a global basis has more than doubled since 1980 (WHO 2011). In
Western Europe, the poorest are those most affected by obesity with 20-25%
of low income men and 40-50% of low income women being obese (Robertson,
Lobstein, Knai 2007).
Climate change will have an increasing impact on food yields, nutritional quality,
food safety and affordability – an impact that will affect some groups disproportionately
with the most socially disadvantaged, the oldest and the youngest
being most vulnerable. People on low incomes will be able to purchase only the
cheapest foods, which are often energy dense, highly processed products that
increase the risk of obesity and diabetes. In the long term, and at the global level,
fewer people will be able to afford even these cheap foods (Friel et al. 2008).
People’s food choices are
influenced by availability and
price, attractiveness and
commercial marketing, and
also by personal, cultural
and societal norms and
values.
Challenges and opportunities for sustainable lifestyles 69