• Public health is informed by social variants such as politics, education and the economy – and yet it is perceived to relate only to doctors and medicines.
  • A new report looks at how data could be used to get a better understanding of the social determinants of health.
  • Using principles of transparency, equity and diversity, we can put health at the heart of all policy-making.

Our health is inextricably linked to social determinants – the upstream forces such as culture, politics, the accessibility of education, and the economy, that shape our lives. And yet, when we talk about health, we tend to overlook these wider issues. Health is often perceived to relate only to doctors and medicines, and investing in health tends to be understood as investing in health care, rather than taking a wider view of the social determinants.

The ubiquity of this limited understanding of health was evident in the results of a multi-country survey launched by the Rockefeller Foundation-Boston University 3-D Commission. The survey was conducted in eight countries spanning the wealth spectrum and found that about a quarter (24.6%) of 8,000 participants ranked healthcare as the most important determinant of health. Education was a distant second at 19.3%, while several well documented foundational causes of health (e.g., childhood conditions and income) were ranked as the most important determinants by fewer than 10% of the participants.

It is critical, then, that we increase the visibility of the full range of forces that shape health. This has been a core focus of public health at the local, national, and global levels. Importantly, many social determinants, such as housing and employment, will be shaped over the next few decades by global population trends, such as urbanization, migration, and inequities. These trends will present both challenges and opportunities when it comes to public health.

New technologies and their ever-evolving uses have generated a wealth of information about how social determinants impact public health. This has the potential to inform better choices about health at the policy level. For example, analyses of consumer choice data can potentially be used to monitor the nutritional quality of the food, and to inform policies aimed at tackling malnutrition.

The Rockefeller Foundation-Boston University 3-D Commission sought to bridge gaps between the worlds of data, the social determinants of health, and practical policymaking. Our report on how the intersection of data and social determinants can inform better decision-making about health was launched to coincide with the 76th United Nations General Assembly. It articulates six key principles to help shape a healthier world.

3-D Commission Principles
The better we understand the social determinants of health, the better we can advance a comprehensive, equitable vision of health for the 21st century
Image: The Rockefeller Foundation-Boston University 3-D Commission

The six principles are:

1. Evidence-based decision making to promote healthy societies – this should go beyond healthcare and incorporate data on the broader determinants of health;

2. All decisions about investments in any sector need to be made with health as a consideration;

3. Decision-making that affects the health of populations needs to embrace health equity, while acknowledging trade-offs between short- and long-term costs and benefits;

4. All available data resources on the social determinants of health should be used to inform decision-making about health;

5. Data on the social determinants of health should contribute to better, more transparent and more accountable governance; and

6. Evidence-informed decision-making to promote health societies needs to be participatory and inclusive of multiple and diverse perspectives.

Our hope is that these principles will help to inform policy-making that puts health at the heart of society. The better we understand the wider determinants of health, through robust engagement with data science, the better we can advance a comprehensive, equitable vision of health for the 21st century.