Social Inequalities in Health and Medical Care for Patients

Socio-economic factors play a role in health that is more significant than biological factors or even the health system itself. Recent data indicate that population health is determined by 80% by the social and economic environment. The social determinants of health (income, education, housing, food security, employment, working conditions, social protection, and access to healthcare) represent the contexts in which people are born, grow, live, and age.

It is thus observed that members of the most disadvantaged socio-economic groups bear the heaviest burden of morbidity. Consequently, most determinants lie outside the traditional health sector, yet their impact on health services is substantial. In 2008, the World Health Assembly adopted a resolution to reduce health inequalities, taking into account the major recommendations of the Commission on Social Determinants of Health.

Within the health system, physicians are key actors in serving communities. They apply innovative approaches to respond to the needs of the most vulnerable populations and, in theory, possess the necessary competencies in clinical practice to optimise the care they provide, while taking into account social factors that have a detrimental effect on health. However, it can be observed that over recent decades, medical training has placed strong emphasis on technical competence and specialisation.

This approach has succeeded in producing highly skilled physicians who are primarily focused on medical issues, where the health approach remains weakly centred on the community and the patient in both training and practice, which may limit the achievement of more meaningful health outcomes. With the aim of contributing to efforts to improve health indicators, several questions may be raised regarding medical practice among our physicians:

Are physicians aware of the socio-economic dimension in the occurrence of diseases and in patient management?Are they able to ensure high-quality and equitable medical and health care for all citizens, taking health determinants into account?Do they establish links between patients and available support programmes (institutions, associations) in order to support adherence to treatment plans?Do physicians’ working conditions influence the extent to which social determinants of health are taken into consideration?What is the perspective of patients and their families?How have public health policies evolved? What measures have been taken by health authorities, particularly at the local level, to reduce social inequalities?