Mr. Gordon Caruana Dingli, President of MAM, introduced the topic of social determinants of health and argued that these are not only significant in less developed countries since social gradients exist even in affluent societies. His main message was that measures to reduce inequities require commitment at all levels: political, social, and individual healthcare professionals.
The conference was opened by the Hon. Parliamentary Secretary Mr. Chris Fearne who described social determinants of health as being the area where politics and health interact. He believes that politicians should work together in a whole-of-government approach and take policy decisions that would improve these social factors, to ultimately lead to an improvement in public health.
Dr. Solaiman Juman, President of the Commonwealth Medical Association described social determinants of health as being the root causes of the causes of ill health and argued for investment in areas other than healthcare, to indirectly improve public health. His main message was that countries should aim to improve empowerment and health literacy of their population, mainly through education.
Dr. Natasha Azzopardi Muscat, President Elect of the European Public Health Association presented statistics which clearly show that Malta is not immune to social gradients. Differences in educational level, gender, ethnicity, household income and even living in certain regions are associated with differences in rates of mortality, health, level of physical activity, BMI, and presence of certain diseases. She also argued the case that general socioeconomic, cultural and environmental conditions influence outcomes in health as much as, if not more than, individual lifestyle factors. The former is causing social gradients to increase, especially post-financial crisis, and is due to the non-implementation of preventive interventions. Countering this trend requires the will and the means to make change happen. Further research, implementing effective policies and sharing of best practice across the EU and Commonwealth are key to reducing health inequalities.
Mr. Duncan Selbie, CEO of Public Health England followed up on Dr. Azzopardi Muscat’s recommendations by listing the most important contributions to reducing inequity in health: employment and housing. These would provide a positive feedback by decreasing risks to health, and increasing income, access to healthcare, education and ultimately better health.
Sir Michael Marmot, who chaired the WHO Commission on Social Determinants of Health and is now President of the World Medical Association, presented evidence that showed how interventions in early childhood can help children in the lowest quintile of development to catch up with their peers who are in the highest quintile of development if placed within a better socioeconomic environment. Similarly, countries which have high levels of social mobility have less income inequalities. Inequities in the current generation are damaging the chances of future generations, further perpetuating the problems. He argued for giving children the best start in life possible, creating fair employment and good work, ensuring a healthy standard of living and growing old healthily. Inequalities are inevitable but it is up to us to change the magnitude of inequalities. Do something, do more, do better!
Ms. Mary Ann Sant Fournier, President of the Malta Chamber of Pharmacists introduced Mr. Raymond Anderson, President of the Commonwealth Pharmaceutical Association who reiterated the message that we should follow the social model of care which is based on the understanding that in order for health gains to occur, social, economic and environmental determinants must be addressed. He believes resources should be channelled towards building social capital – interventions which increase community awareness, connections and relations. He presented a programme (Building the Community- Pharmacy Partnership) which takes advantage of the close contact that community pharmacists have with their communities, to create a partnership between them, encourage community activity and empower people. This could lead to a reduction in health inequalities.
Finally, the Rt Hon. the Lord Kakkar concluded that the true underlying factors for improving health are not the technology and procedures that are available in specialist institutions, but the general socioeconomic, cultural and environmental conditions within our society. We need to turn our attention to these determinants of health and work towards equity in our societies. This requires action at all levels..