[MUSIC]. When many people think of health, they think of health as an outcome of the health care system. But someone's health is determined by doctors, vaccines and clinics, or access to them. When many people think of NCDs, or non-communicable diseases, they think of the lack of healthcare. And the need for healthcare medicines and surgery. That health equals healthcare, and healthcare equals health. But actually it is not that simple. When you look across the global statistics or within most nations, NCDs are linked with some very different factors. NCDs are actually linked with poverty, lower levels of education, lower standards of housing, poorer neighborhoods, unemployment, and the list goes on. Access to education, transport, a place to live, employment, and freedom from discrimination. All of these factors are key when it comes to NCDs. And putting them under one umbrella, we call them the social determinants of health. The social determinants of health in NCDs are the causes behind the causes. The upstream social and economic factors that largely but insidiously dictate the health and disease of individuals and populations. The notion recognizes that the conditions in which we live, work, learn and play, all heavily influence the health that we can achieve. The social determinants of health are the conditions in which people are born, grow and age. Looking further up the tree, the social determinants of health are also influenced by the political environment and policies. Economic development and stability, trade, the natural environment and resources, and the private sector. They all shape and are shaped by the distribution of money, power, and resources at the global, national, and local levels. For example, the European Financial Crisis, an outcome of economic and political influences has seen a rise in suicides and heart attacks at a population level, partly as an outcome of austerity, a political response. The World Health Organization explains that the social and economic conditions, and their effects on people's lives determine our risk of illness, the actions we can take to prevent ourselves becoming ill, and our abilities to treat illness when it occurs. Imagine a middle aged woman presents to her doctor with an outcome of heart disease. Biologically, it may be cholesterol or even obesity, which led her to her disease. But what factors lead to these? What is her level of health knowledge? What were her coping and health practices? What biological or genetic predispositions did she have? What about her childhood, and the environment in which she grew up? Income and social status, education, and employment opportunities? What social supports did she have to avoid the disease? Think of social determinants as the root causes of health and disease. But how do they affect health? And in particular NCDs? Poverty leads to a lack of health access, but also less opportunities for employment, health education and social inclusion. Poverty is almost universally linked to higher rates of smoking, alcohol consumption and in most regions, obesity and NCDs themselves. Low levels of education lead to a lack of understanding around how to avoid NCDs, what to eat and how to access treatments. Urbanization and migration of populations can disrupt the social fabric and health resilience of communities. Globalization leads to greater flow and presence of processed foods, alcohol and tobacco. And industrialization can increase environmental pollutants. Urbanization and globalization are not bad, but they come with risks to the social determinants of health which must be managed. So let's recap. The way we live, our access to education, employment, quality housing, and a safe living environment and more, in part dictate our health. Both in terms of the risks of developing disease, but also in accessing treatments after you become ill. In other words, poor social determinants lead to a higher risk of illness and a lower chance of having suitable healthcare access, which leads to illness. Which in turn leads right back to a deeper level, or a new generation of poor social determinants. So how do we address social determinants, and who needs to be involved? Addressing social determinants requires working on all causes of loss, of the loss of health in our society. We can continue to only treat the rising burden of diabetes and heart disease, which of course is still an important social investment. Or we can also address issues, such as a lack of education around prevention, rising mental health burden caused by economic and social hardships and tackle unaffordable housing and healthcare, which will in turn lead to greater community health, and reverse the cycle of deprivation and the ill health it causes. The final report of the World Health Organization's commission on social determinants of health stated non-communicable diseases cannot be effectively addressed without action on social determinants of health. Without addressing social inequalities and conditions, along with the reasons that the health system works better for some people than for others, that is, adopting a social determinants approach. Without doing this, prospects for reversing the NCD epidemics are poor. 80% of NCDs could be prevented through primary prevention. Through modifying risk factors and behaviors, such as reducing tobacco consumption, and fat, alcohol and salt intake, preventing obesity and promoting physical activity and improving environmental conditions such as air quality and urban planning. This is where a social determinance approach to NCDs is key. So, does health equal health care? Well, in part yes, but the health care sector cannot by itself mitigate NCDs. The strategy of identifying risks and expecting individuals to simply avoid them, does not work on the level of change that we need. Preventing and mitigating NCDs require the input, focus, and collaboration of many sectors, including finance, trade, agriculture, housing, education, urban planning, transport, and even environment. Furthermore, NCDs arise from exposures throughout the life course. Starting before even born, in utero. Therefore, we need a much more comprehensive and long-term approach, including childhood determinants for adult disease. Rasanathan and Kretch stated implementing a social determinance approach will emphasize the importance of building health, but also health equity across societies. A cycle of health and prosperity is possible whereby improvements in health and its determinants feed back into each other, providing mutual benefits, co-benefits outside of health and lasting social improvements. And better health contributes to increased well being, education, social cohesion, environmental protection, increased productivity and even economic development. So what's the take home message? Health is to a large part dictated by, and a dictator of the opportunities we have, and the environment we live in. Addressing NCDs means addressing the root causes of disease. And the systemic, upstream determinants, across multiple sectors, which percolate through and predispose ill-health. This is a social determinants approach to NCDs. And this is a vision for us all [MUSIC]
