Can individual doctors make a difference?
In July's think piece, Sir Michael Marmot of University College London addressed the social determinants of health and the implications for individual doctors.
Read Sir Michael's thoughts and read your feedback from last month on whether individual doctors can make a difference.
Social determinants of health and the medical profession
The key determinants of health inequalities lie outside the health care sector. That said, the medical professions are well placed to play a key role in tackling health inequalities.
Often, those working in the healthcare profession have first hand awareness of the effect of poverty on their patients and the relationship between social disadvantage and health.
Healthcare professionals are also in a good position to implement successful programmes to tackle inequalities; they have frequent contact with most of the population and build relationships with individuals and forge links with communities. Doctors are highly trusted, and this improves their chances of success in understanding and working within communities.
In my strategic review of health inequalities in England, Fair Society Healthy Lives (pdf), we suggested that there are three clear roles for the medical profession:
Putting our own house in order
In the first category we argue for ensuring equitable access - a potentially even more important issue with massive changes to the NHS afoot - and greater emphasis on prevention and health promotion.
The public health White Paper advocates extensive partnership working between the new Public Health Service and the NHS: "the NHS has a crucial role to play in public health. This includes ensuring that health services meet the needs of the whole population, including disadvantaged groups, (and) taking every opportunity that health services have to prevent illness and promote health."
Advocacy and cross-sector working
In the second category, advocacy and cross-sector working, comes the key focus on social determinants of health. In Fair Society Healthy Lives we took a life course approach and made recommendations in 6 domains:
- Give every child the best start in life
- Education and life-long learning
- Employment and working conditions
- Minimum income for healthy living
- Healthy and sustainable places and communities. (Subsequently we published a report on fuel poverty showing how important well-insulated housing is both to health inequalities and to the environmental agenda
- Social determinants approach to prevention.
Doctors can be advocates in each of these areas as well as working in partnership with deliverers of these services. A practice such as that in Bromley-by-Bow, situated in a community centre, shows how general practitioners work hand in glove with all the vital services that impact on people's health.
The transfer of some public health functions from Primary Care Trusts (PCTs) to Local Authorities provides opportunities to draw action on the social determinants and health together.
Knowledge, understanding and evaluation
The third and crucial area relates to knowledge. The medical profession has a good record of seeing what works and monitoring effects of interventions. In the area of social determinants and health inequalities the variety of activities across the life course that have potential good effects need to be monitored and assessed to see if they fulfil their promise.
I was struck by the activities of the Merseyside Fire and Rescue Service. Fire fighters have become active across a whole range of social determinants of health - from helping people to improve their housing, action on smoking, working with young people and older people. If the fire fighters can do it so can we!
Sir Michael Marmot June 2011
Now you've heard from Sir Michael - don't forget to read your feedback from last month on whether individual doctors can make a difference and sign up to our email updates to stay in touch with the review.