To be poor is by definition to have less of the good things in life, including health and longevity. Obtaining equal access to care is a major step in improving health, however, improved access to health services is only part of the solution for advancing health, avoiding illnesses and enhancing well-being. Th e fact remains that people at the bottom of society are faced with the worst living conditions and report the worst health outcomes. Regardless the country these poor people live in, what type of health insurance they have or do not have, and the level of health care they receive, they still have the worst health of all. These disparities cannot be explained by biological differences. The World Health Organization holistically viewed the social determinants of health, concluding that global health and illness follow a social gradient; lower socioeconomic positions are consistently correlated with poorer health. Th ese avoidable health inequalities arise because of the circumstances in which people are born, live, work, and age, including the adequacy of health care systems. Th e conditions in which people live and die are, in turn, shaped by social and economic forces. Together, the structural determinants and conditions of daily life constitute the socioeconomic determinants of health. These are responsible for a major part of health inequities between and within countries, and constitute one form of social injustice. Global action focused on the socioeconomic determinants of health is necessary to achieve health equity. Since neighbourhoods and communities are amendable to intervention, they are the most appropriate social levels at which to improve the health of populations. Most human development programs seek as a primary goal to improve the subjective well-being of those most aff ected by poverty. In 2000, 189 countries signed the United Nations Millennium Declaration, which set eight Millennium Development Goals (MDGs) to be achieved by 2015. Th ese MDGs aim to decrease poverty, inequality and improve health and subjective well-being; the latter is increasingly recognized as an important additional source for the evaluation of broad societal and economic development. Communities and neighbourhoods with high levels of subjective well-being are essential for health equity. An accumulating body of knowledge has shown that subjective well-being is a strong predictor of physical health and longevity, spurring growing interest in this factor.

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South Africa Netherlands Research Programme on Alternatives in Development (SANPAD)
J.J. van de Klundert (Joris)
Erasmus University Rotterdam
Erasmus School of Health Policy & Management (ESHPM)

Cramm, J. (2010, December 14). Health and social burdens of people living in an economically and health-deprived area. Retrieved from