Good health is important for both individuals and society as a whole, but not everyone has the same opportunities for good health. Extensive research has shown that differences in social and economic circumstances lead to deep inequalities in health outcomes.,, For example, there is currently a 19-year gap in healthy life expectancy between women in the most- and least-deprived areas of the UK.

Yet public, media and policy discourse tends to be dominated by concerns about the NHS and issues such as diet, exercise and smoking. This means that public debate rarely acknowledges the health effects of issues like housing, education, welfare and transportation. As a result, policy and investment decisions often miss opportunities to protect and enhance health. For example, while investment in the health care system in England has increased in recent years, there have been deep cuts to public spending in areas relevant to the social determinants of health, including public health.

If the necessary action to improve health and reduce health inequalities is to be taken, there needs to be greater awareness of the social determinants of health, beyond those working in the field. This type of policy shift – like shifts on other social issues such as tobacco control, use of plastics and climate change – is only achieved when it is in step with broader public opinion.

Achieving such a change in public attitudes is difficult, but not impossible. It requires careful and effective communication of the evidence, which in turn needs to be informed by a detailed understanding of the public’s prevailing views and assumptions. How a message is understood depends on people’s underlying beliefs, which shape the way they interpret the information they receive.

The FrameWorks Institute – an independent, non-profit organisation – works with organisations and social movements to discover the patterns in public thinking and discourse that impede social change and identify reframing strategies that can drive change. They start from the premise that how communicators choose to frame issues – how they present information, including what they emphasise, how they explain things and what they don’t say – influences how people make sense of and engage with these issues. In turn, adopting better ways of framing issues can lead to changes in the way the public thinks about and engages with these issues.

Using this methodology, FrameWorks explored public understanding of the social determinants of health. This work identified several distinct challenges that need to be understood and addressed in order to better communicate the evidence on the issue.

This work is designed to inform and empower public health professionals, policymakers, civil-society leaders and anyone who has an interest in promoting a broader understanding of how to build a healthier society. The second stage of this work, planned for 2019, will develop and test detailed messages and tools for communicating the social determinants of health more effectively.

Box 1: What are the social determinants of health?

The social determinants of health, also known as the wider determinants of health, are the conditions in which people are born, grow, live, work and age. They include social, cultural, political, economic, commercial and environmental factors.

The strongest influences on people’s health are social determinants such as their level of education, income, quality of housing and employment.

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