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?
Peter Prontzos




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