As Good as It Gets

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SOCIAL DETERMINANTS OF HEALTH

International Centre for Health and Society

SOCIAL DE TER MI NANTS OF HEALTH

THE SOLID FACTS
SECOND EDITION
Edited by Richard Wilkinson and Michael Marmot

WHO Library Cataloguing in Publication Data Social determinants of health: the solid facts. 2nd edition / edited by Richard Wilkinson and Michael Marmot. 1.Socioeconomic factors 2.Social environment 3.Social support 4.Health behavior 5.Health status 6.Public health 7.Health promotion 8.Europe I.Wilkinson, Richard II.Marmot, Michael. ISBN 92 890 1371 0 (NLM Classification : WA 30)

Address requests about publications of the WHO Regional Office to: • by e-mail publicationrequests@euro.who.int (for copies of publications) permissions@euro.who.int (for permission to reproduce them) pubrights@euro.who.int (for permission to translate them) • by post Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark

ISBN 92 890 1371 0
© World Health Organization 2003 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. Printed in Denmark

CONTENTS

Foreword Contributors Introduction 1. The social gradient 2. Stress 3. Early life 4. Social exclusion 5. Work 6. Unemployment 7. Social support 8. Addiction 9. Food 10. Transport WHO and other important sources

5 6 7 10 12 14 16 18 20 22 24 26 28 30

The World Health Organization was established in 1948 as a specialized agency of the United Nations serving as the directing and coordinating authority for international health matters and public health. One of WHO’s constitutional functions is to provide objective and reliable information and advice in the field of human health, a responsibility that it fulfils in part through its publications programmes. Through its publications, the Organization seeks to support national health strategies and address the most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad...
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