According to Sir Michael Marmot, a leading expert on health inequalities, the most pressing social issues in the UK are closely tied to health disparities and social determinants of health.[i] These issues include:
- Health Inequalities: There is a clear social gradient in health, with life expectancy and health outcomes worsening as deprivation increases.[ii] This gradient has become steeper over the last decade.[iii]
- Child Poverty: Child poverty rates in the UK are high, with 22% of children living in poverty, compared to Europe’s lowest rate of 10%.[iv], [v]
- Regional Disparities: There are marked regional differences in life expectancy and health outcomes, with deprived areas in the North East faring worse than other regions.[vi]
- Social Determinants of Health: Factors such as quality of housing, access to food, education, and fair employment significantly impact health and wellbeing.[vii]
- Impact of Austerity: Cuts to local authority budgets have disproportionately affected the most deprived areas, exacerbating health inequalities.[viii]
- Impact of COVID-19: The pandemic has further exposed and amplified these underlying inequalities, with death rates higher in certain groups and areas.[ix]
Marmot advocates for a comprehensive approach to address these issues, focusing on social determinants of health and implementing policies that promote health equity.[x] His recommendations include giving every child the best start in life, enabling all people to maximise their capabilities, creating fair employment and good work for all, ensuring a healthy standard of living for all, creating and developing sustainable places and communities, and strengthening the role and impact of ill-health prevention.[xi],[xii]
Determinants of Health
According to Sir Michael Marmot, the social determinants of health are the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels, which in turn are influenced by policy choices. Marmot emphasises that health inequalities result from social determinants and that these inequalities are not only unfair but also avoidable.
Marmot’s work suggests that addressing these social determinants is essential for reducing health inequalities and improving the overall health of populations. According to Sir Michael Marmot, social determinants of health significantly affect health outcomes. These determinants include the conditions in which people are born, grow, live, work, and age, and are shaped by the distribution of money, power, and resources at global, national, and local levels.
Poverty, inequality in income and assets, and social exclusion are key social determinants that drive health inequalities. For instance, adverse conditions in childhood can lead to fewer opportunities for meaningful and fulfilling employment in adulthood, which in turn affects health outcomes.
Education is another crucial determinant. Higher levels of education generally lead to better health outcomes. Similarly, employment and working conditions, such as job security and work environment, significantly influence health. Access to healthcare services is a determinant of health, but Marmot emphasises that healthcare is not the only factor. The environment, including safe housing and communities, is also a crucial determinant of health.
Marmot’s research suggests that addressing these social determinants is essential for reducing health inequalities and improving the overall health of populations. He advocates for a comprehensive approach that includes giving every child the best start in life, enabling all people to maximise their capabilities, creating fair employment and good work for all, ensuring a healthy standard of living for all, creating and developing sustainable places and communities, and strengthening the role and impact of ill-health prevention.
Marmot’s research has identified several key areas that are considered social determinants of health:
- Income and Social Protection: Economic status has a profound impact on health, with poverty being a significant determinant.
- Education: Educational level is closely linked to health outcomes, with higher education levels generally leading to better health.
- Employment and Working Conditions: Job security, work environment, and stress related to work can influence health significantly.
- Social Inclusion and Non-discrimination: Social support networks, social cohesion, and the absence of discrimination are important for mental and physical health.
- Healthcare Access: Access to healthcare services is a determinant of health, although Marmot points out that healthcare is not the only factor.
- Environment: Safe housing, communities, and general environmental conditions are crucial determinants of health.
The Marmot Review, led by Sir Michael Marmot, proposed six key policy objectives to address the social determinants of health and reduce health inequalities:
- Give every child the best start in life: This involves investing in early childhood development and education to ensure that all children can reach their full potential.
- Enable all children, young people, and adults to maximise their capabilities and have control over their lives: This includes promoting lifelong learning and ensuring that people have the resources and opportunities to lead fulfilling lives.
- Create fair employment and good work for all: Good employment conditions, job security, and fair wages are crucial for health. This objective involves promoting fair labour practices and ensuring that all people have access to good work.
- Ensure a healthy standard of living for all: This involves implementing policies to reduce poverty and ensure that all people have access to the resources they need for a healthy life, such as nutritious food and safe housing.
- Create and develop healthy and sustainable places and communities: This includes promoting safe and healthy environments, such as clean air and access to green spaces, and fostering strong, supportive communities.
- Strengthen the role and impact of ill-health prevention: This involves investing in healthcare services and public health initiatives that prevent illness and promote health, rather than just treating disease.
These policy objectives are underpinned by the principle of proportionate universalism, which means that actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. This approach recognise that health inequalities result from social gradients in health, and therefore, interventions must be designed to address these gradients.
Tackling Social Inequalities Using Media
Media plays a significant role in addressing the social determinants of health inequality. The media can be used to raise public awareness about the impact of social determinants on population health and to educate policymakers. It can also help in reducing and eliminating health disparities. News media messages about the social determinants of health can influence public health policy and public opinion. However, the impact of these messages can vary depending on the political beliefs of the audience.
Digital media, including social networking sites and other online platforms, are emerging as important platforms for communication and health information exchange. Digital inclusion, which refers to access to and the ability to use digital technologies, has been called a “super social determinant of health” because it can influence all other social determinants.
However, there are also communication inequalities that can limit access to life-saving health information, particularly among racial and ethnic minorities, older people and poorer people. Health literacy, which is the ability to obtain, read, understand, and use healthcare information to make appropriate health decisions, is another important factor that mediates the association between socioeconomic status and health outcomes. Therefore, while the media can play a crucial role in addressing social determinants of health inequality, it is also important to address the inequalities in access to and use of media.
Using the media to address social determinants of health inequality faces several challenges, as highlighted in the research. Some of these challenges include:
- Communication Inequalities: Certain segments of the adult population may have limited access to and use of social media and other online platforms, creating communication inequalities in the dissemination of health information.
- Digital Divide: The digital economy’s rapid development has left behind a detailed study of the impact of the digital divide on healthcare disparities, limiting access to health information for some groups, particularly those who are more vulnerable to health disparities.
- Polarising Effect: News media messages about the social determinants of health can lead to a polarising effect, causing divergence in public responses, particularly along political lines.
- Persistent Communication Inequalities: Racial/ethnic minority groups may face persistent communication inequalities, limiting their access to life-saving health information and making them more vulnerable to the effects of social determinants of health.
- Health Media Consumption Disparities: Low education and low income are associated with disparities in health media consumption, which can impact risk perception and health outcomes.
- Limited Research: There is a need for more comprehensive research to understand the impact of the digital economy on healthcare disparities and the relationship between the Internet, health inequality, and healthcare access.
Addressing these barriers requires targeted efforts to reduce communication inequalities and ensure that all individuals have equal access to life-saving health information. To overcome communication inequalities in addressing social determinants of health inequality through media, several strategies can be implemented:
- Research on Inequality in Communication: Conduct research to understand how inequality in communication contributes to and exacerbates existing health disparities. This can help in identifying the specific areas where communication inequalities are most prevalent.
- Intervention and Policy Options: Explore intervention and policy options that could bridge information inequities to reduce health disparities. This may involve targeted communication strategies to reach underserved populations.
- Capacity Building: Build the capacity of community groups in accessing and using evidence-based information to make appropriate health decisions. This can involve training and support for community organisations to effectively communicate health information.
- Barriers Faced by Healthcare Providers: Identify and address the barriers faced by healthcare providers in obtaining and using the latest scientific information and providing information to make appropriate decisions regarding treatment. This can involve improving access to up-to-date health information for healthcare professionals.
- Digital Inclusion: Address digital inclusion as a social determinant of health. This involves ensuring that all individuals have access to digital technologies and the skills to use them effectively, as digital inclusion can influence all other social determinants of health.
By implementing these strategies, it is possible to reduce communication inequalities and improve the effectiveness of the media in addressing social determinants of health inequality.
Community Media’s Role
Maintaining legacy forms of media for the use and benefit of communities is a practical and effective approach to communicate with marginalised groups affected by health inequalities, particularly those who have limited access to digital technology. Traditional media channels like radio, television, and print newspapers are still widely accessible and familiar to many, including the elderly, lower socioeconomic groups, and residents in remote areas.
These forms of media provide a reliable source of information, critical for those who might not have the means or skills to navigate the digital landscape. They offer straightforward, curated content that can be crucial in disseminating health-related information, public health campaigns, and services that might otherwise be missed by these populations. These platforms are well tested and are relatively low-cost when compared to untested forms of digital engagement.
Legacy media, when deployed as a form of community-focussed communication, can play a vital role in raising awareness about health challenges and remedial actions. Through news reports, features, discussions, and interviews, traditional forms of media can enable people to highlight for themselves the challenges they face, fostering a broader understanding and empathy for themselves and among the public.
Whose voices and stories are expressed and heard in these discussions? Enabling everyone in society to speak for themselves, and with people like themselves, about topics that relate to their experience, must be built-in to the more general conversations that policymakers and politicians have when tackling health inequalities.
In essence, while the digital media revolution continues to advance, it should not be given a free ride. We need to understand what benefit digital technologies give us, over and above legacy forms of media. Legacy media, in the form of radio, newspapers, community notice boards, face-to-face groups, and so on, remain a key tool in reaching and engaging with groups at risk of being left behind, ensuring that important health messages and information are communicated effectively to all sectors of society.
Community media can play a crucial role in addressing social disparities in health and wellbeing by bridging communication inequalities and providing access to health information. Research suggests that traditional communication inequalities are muted when it comes to social media use, providing great potential for bridging access to health information. Community-based organisations (CBOs) can use social media to engage with underserved populations, thereby reducing communication inequalities and addressing health disparities.
Additionally, while social networking sites are emerging as important platforms for communication and health information exchange, it should not be assumed that they are a universal answer to the problems of health disparity. Too often, social media is individualistic, prone to misinformation, and lacks any sense of accountability and trust. We have to interrogate the needs of people based on their actual social experience and seek to understand how people use different media platforms, and the different roles that these platforms can play in helping to reducing health disparities.
We need to thoroughly examine our communication infrastructure, including community media outlets, and test their ability to play a role in improving public health. Public investments and support for minority-serving media and community outlets are needed to ensure that all individuals have access to life-saving health information, thereby reducing vulnerability to health disparities. Community approaches to addressing health disparities, especially those that emphasise the importance of community-level factors, need to be better understood and tested for their ability to build capacity in society and communities, and thereby help with reducing health disparities.
[i] https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
[ii] https://www.instituteofhealthequity.org/about-us/about-professor-sir-michael-marmot
[iii] https://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on
[iv] https://pubmed.ncbi.nlm.nih.gov/15781105/
[v] https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00691
[vi] https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on
[vii] https://factor.niehs.nih.gov/2021/7/community-impact/social-determinants
[viii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10028533/
[ix] https://www.health.org.uk/publications/build-back-fairer-the-covid-19-marmot-review
[x] https://www.youtube.com/watch?v=BHYBHKma3x8
[xi] https://www.local.gov.uk/marmot-review-report-fair-society-healthy-lives
[xii] https://www.rcn.org.uk/magaines/People/2021/September/Professor-Sir-Michael-Marmot-health-equity-keynote-speech