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EDITORIAL

Social determinants of health: time for action

By the time, you receive this 

issue of the journal, the joint 5th 

WONCA Africa and 20th South 

African Academy of Family 

Physicians conference would 

have ended in Pretoria South 

Africa on 20 August 2017. The 

theme of the joint conference 

forms the basis of this editorial. 

So what is “Social Determinants 

of Health (SDH)”? The World 

Health Organization (WHO) 

defines it as 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. The SDH are 

mostly responsible for health inequities – the unfair and avoidable 

differences in health status seen within and between countries. It 

is acknowledged that “health equity and social determinants” are 

critical components of the post-2015 sustainable development 

goals (SDG) global agenda and of the push towards progressive 

achievement of universal health coverage (UHC). If we have to 

reduce health inequities, the approach will be to address both 

SDH and UHC in an integrated and systematic manner.1

In October 2011, member states adopted the Rio Political 

Declaration at the World Conference on Social Determinants 

of Health in Rio de Janeiro, Brazil. The Rio declaration called for 

action in five main areas namely1: 

a. Adopt improved governance for health and development; 

b. Promote participation in policy-making and implementation; 

c. Further re-orient the health sector towards promoting health 

and reducing health inequities; 

d. Strengthen global governance and collaboration; and 

e. Monitor progress and increase accountability. 

In May 2012, WHO Member States at the Sixty-fifth World 

Health Assembly (WHA) in Geneva, Switzerland endorsed the 

Rio Political Declaration. However, it is imperative to assess 

the progress since the 2010 Rio Political Declaration on SDH. 

The 2015 WHO Progress Report presented at the Sixty-eighth 

World Health Assembly dated 24 April 2014 lists a number of 

initiatives that have addressed the SDH agenda. These include 

the following which I consider relevant to Africa2: 

a. In 2013, the Regional Office for Africa published the strategy, 

‘Health promotion: strategy for the African Region’, which 

included a strong emphasis on health in all policies. 

b. WHO advanced a methodology to support national health 

programmes to improve equity results (drawing from the 

fields of social determinants, gender and human rights).

c. In 2014, the Regional Office for Africa established a technical 

group to support work on social determinants and conducted 

health equity analyses in four Small Island States. 

d. Progress was made by WHO in addressing equity, social 

determinants, gender and human rights through its work 

involving normative guideline development processes, 

including the Guidelines Review Committee.

e. Led by WHO and UNICEF, ‘Every newborn: an action plan to end 

preventable deaths’ was published in 2014, and has a strong 

focus on equity and determinants.

Despite WHO progress on SDH activities in various Member 

States, the impact of the Rio Declaration is yet to be felt within 

the various Member States’ health systems. In 2014, Mayosi BM 

and Benatar SR published an article in the New England Journal 

of Medicine titled ‘Health and Health Care in South Africa —  

20 Years after Mandela’. They concluded that, “Much of the hope 

for narrowing disparities in the new South Africa was embedded 

in the reversal of legislated racial discrimination generally 

and in aspirations for more equitable provision of health care 

specifically. But this places too much emphasis on legislation 

and biomedicine as the dominant routes to improved health, 

without consideration of the social determinants of health and 

the complexity associated with the effective practical application 

of new laws and health services”.3 So what has changed for 

the majority of the South African people with regards to the 

implementation of the SDH goals? This will be unpacked in the 

next editorial. 

Food for thought!

Prof. Gboyega A Ogunbanjo 
Editor-in-chief: SAFPJ 

References:
1. World Health Organization (WHO). Social determinants of health: What are social 

determinants of health? [Accessed 09 August 2017]. Available from: http://www.
who.int/social_determinants/sdh_definition/en/ 

2. World Health Organization (WHO). Sixty-eighth World Health Assembly: WHO 
Progress Report. 24 April 2014 [Accessed 09 August 2017]. Available from: http://
apps.who.int/gb/ebwha/pdf_files/WHA68/A68_36-en.pdf 

3. Mayosi BM, Benatar SR. Health and Health Care in South Africa — 20 Years after 
Mandela. N Engl J Med. 2 October 2014 [Accessed 10 August 2017];371:1344-53. 
Available from:  http://www.nejm.org/doi/full/10.1056/NEJMsr1405012  doi: 
10.1056/NEJMsr1405012