The Social Determinants of Health

by Peter Prontzos

This post contains a portion of the talk that I gave last month at the 16th International Conference of the Association of Psychology and Psychiatry for Adults and Children in Athens. While I began with a short discussion of primal theory, I also wanted to stress how social and economic factors create the basis for much of the pain in our lives.

Research has now clearly established that economic, and social variables – more than individual or family behavior – are the most salient factors overall in determining a child’s well-being.

Epigenetics, for instance, explores how the social and economic experiences of one’s parents and even grandparents are transmitted to a fetus by influencing whether genes are turned on or off.

And psychologist Monique Robinson points out that:

Regardless of exposure to stress in the womb, a nurturing environment after birth can provide the child with enormous potential to change their course of development. This is known as “developmental plasticity,” which means that the brain can adapt and change as the child grows with a positive environment.

The important message here is in how we as a community support pregnant women.  Stressful lives are most often linked with socioeconomic disadvantage. This research shows we should be targeting these women with support programs to ensure the stress does not negatively affect the unborn child.

Not surprisingly, poverty can do significant harm to children, including brain damage.  Researchers at UBC and UC Berkeley found that US children from low socioeconomic environments displayed a response in the prefrontal cortex that was similar “to the response of people who have had a portion of their frontal lobe destroyed by a stroke.

Providing optimal conditions for pregnant women, such as nutrition and prenatal care, would prevent children from suffering from a host of cognitive, emotional, and physical illnesses.

Nobel prize-winning economist James Heckman argues that every dollar invested “in the very young” not only saves lives and prevents illness, but it will also save from $4-17 dollars in future social costs.  For instance, toxic chemicals and air pollutants, which result in such outcomes as lead poisoning, ADHD, and autism, cost the United States $77 billion annually.

Almost 350,000 women die each year in childbirth – most of whom could be saved for the cost of – six fighter jets.

The most horrific figure is this: over 22,000 children under the age of 5 die every day from hunger and preventable diseases – almost 9 million every year.

The crime is that the world has more than enough wealth and knowledge to eliminate most of this suffering.

Consider that governments give approximately $400-500 billion dollars every year to wealthy corporations whose activities are destroying the environment.

This year’s US military budget is around $800 billion, and the world spends twice that: $1.6 trillion. Perhaps the simplest (and most rational) change would be to redirect wasteful military spending – one-fifth of which, according to the United Nations, would end the worst elements of global poverty by providing basic levels of health care, sanitation, food, housing and education.

The wars in Afghanistan and Iraq alone will cost over $3 trillion.

Literally trillions of dollars were spent bailing out Wall Street when their dubious investments collapsed, and yet the 25 top hedge fund managers in 2009 “earned” an average of more than a billion dollars each – “more than 24,000 times that of the average American.” Millions lost their jobs and houses, but it’s OK because, in the view of the CEO of Goldman Sachs, they were “doing God’s work” (McQuaig and Brooks, The Trouble with Billionaires, Penguin, Toronto, 2010).

And in 2009, the combined net worth of the world’s 1,011 billionaires increased to $3.6 trillion, up $1.2 trillion in just one year. Just one-quarter of this new wealth could end global poverty.

The single greatest negative influence on the health of children is extreme social and economic inequality (both relative and absolute).  This is just as true for wealthy countries as it is for poor ones, since “high levels of inequality have a negative impact on population health in both rich and poor nations alike.”

It is obvious that trying to “live” on $2/day or less is hardly optimal for one’s physical or emotional health, but almost half the world’s population is trapped in this predicament.  Even a rich country like Canada is nowhere near as healthy as it could be:

The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices, but rather the living conditions they experience…how income and wealth is distributed, whether or not we are employed, and if so, by the working conditions we experience (“Canadians’ health is mostly shaped by social determinants”, CCPA Monitor, June 2010).

Almost everything that is vital to a healthy community, from life expectancy to levels of depression to educational performance to crime rates, is affected by how unequal a society is.  This is true in both rich and poor countries.  Infants and children are the ones most vulnerable to negative social and economic inequalities (The Spirit Level: Why Equality is Better for Everyone, Wilkinson and Pickett).

Perhaps the most important point to remember is that none of the social, economic, and environmental problems are necessary. All scarcities are, as Murray Bookchin pointed out over 40 years ago, artificial. We possess both the knowledge and the wealth to eliminate the worst of these afflictions. Why aren’t we doing so?



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3 Replies to “The Social Determinants of Health”

  1. “None of the social, economic and environmental problems are necessary. All scarcities are artificial. We possess both the knowledge and the wealth to eliminate the worst of these afflictions. Why aren’t we doing so?”

    I think you are overestimating both the knowledge and the wealth. If you cherry-pick the knowledge it may in certain moments give an impression to be available. But even so, what is the value of knowledge if it is not matched with (democratic) power to act, and power is connected to money and money is owned by people and institutions with the bulk of their knowledge concentrated in entrepreneurial and financial specialities. They may donate part of their wealth as long as it is tax deductible but certainly not to change the equilibrium, which is needed, to create a better world with adequate child-rearing leading to a healthier next generation.

    Money and wealth, by the way, is not a fixed value in a free enterprice / society / world. It is an ever fluctuating market illusion. If the fortunes which you have taken out of contexts (which most of us would like to change) were turned into social activities the USA would go amok and we would be brought back into the dark ages of American policy. Why? Americans are for generations brought up with a dream of economical independance “to become a millionaire” which is so deep a neurosis that it will take many generations of Barack Obamas to change it. Saying this I admire since 50 years the average american who I consider generous, friendly and open to foreigners. However, the neurotic American dream of economical independence has had and has a high price, when it comes to social security.

    And what would you do with all the money which theoretically appears to be available? Primal Therapy i.e., which I personally have benefitted from in a miracolous way, has only helped a few and we don’t have more than one genius to explain and exploit it. Very few have relatively seen been helped and the theoretically so easy to understand primal principal cannot be put into work because of the scarcity of therapeuts. Furthermore, do you think that all these people who suffers, that they really want help? I’m not sure the majority of them is thinking about health and love the same way as you or I are.

    Sadly enough evolution and determinism is a harsh route for many of us during most of our time. There are fine periods and interestingly enough it is often when scientific thinking and development improves our conditions as we have our best moments. However, scientific results constantly being mis-used. It is like the brain, we are dependent of the delicate equilibrium between the feeling and the intellectual brain.

    In the long run I’m an optimist with regard to evolution.

    Jan Johnsson

    1. Jan,

      It should be obvious that neither people nor nature will thrive under the capitalist system. As John Maynard Keynes understood: “Capitalism is the astounding belief that the most wickedest of men will do the most wickedest of things for the greatest good of everyone.”

      The alternative is economic democracy, i.e. socialism, where both citizens and workers have real control over their lives and work and the wealth that their labour creates.

      Corporations and the capitalist system are, by their very nature, psychopathic – that is, they have NO concern for how their policies affect human beings or the environment, as long as they make more money. There are literally countless examples of this truth, from the Alberta Tar Sands to the exploding Ford Pinto to the BP oil spill. As capitalist cheerleader Milton Friedman happily pointed out: “Corporations have no social responsibility other than to make as much money as possible for their shareholders.” (See the book or movie, “The Corporation”, by Joel Bakan, for details).

      Capitalism also brings out the worst, most selfish side of human nature. As Albert Einstein observed: “This crippling of individuals I consider the worst evil of capitalism. Our whole educational system suffers from this evil. An exaggerated competitive attitude is inculcated into the student, who is trained to worship acquisitive success as a preparation for his future career. I am convinced there is only one way to eliminate these grave evils, namely through the establishment of a socialist economy.” ( )

      In a democratic socialist economy, the wealth that people create would indeed provide for everyone’s needs, including the need not to be a wage slave and, as Chomsky says, to have control over one’s labour.

      Finally, the solution is not primal therapy for everybody, but creating a humane society in which the amount of trauma inflicted on everyone would be minimized, so the need for therapy would be minimized.


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