The director of PAHO's Department of Social and Environmental Determinants of Health Equity participated in the event Global Investments in Health: The Infrastructure for Everyday Well-Being, organized by the Federal Reserve Bank of New York.
Washington, D.C., February 5, 2025 - Health is not built in hospitals but from factors such as home, education, work, food, environment, among others. For this reason, it is essential to address the social determinants that impact health by working across sectors, with social participation and placing populations in situations of vulnerability at the center of policies and plans. This was the central idea expressed by the director of PAHO's Department of Social and Environmental Determinants for Health Equity, Gerry Eijkemans, at the online event Global Investments in Health: The Infrastructure of Everyday Well-being, organized by the Federal Reserve Bank of New York.
“Moreover, keeping people healthy and with high levels of well-being has a huge socioeconomic impact, which is why health promotion is so important,” Eijkemans reminded.
"There is scientific evidence that promoting healthy lifestyles and prevention not only improves the quality of life of the population, but also reduces healthcare costs and increases productivity, as healthy people are more productive at work. All this therefore implies a positive economic return in the long term," said Eijkemans.
Economic studies have shown that health promotion interventions report a very high return on investment. “Thus, a systematic review on this topic published in 2017 in the United Kingdom demonstrated an average return on investment of public health interventions of 14 to 1. That is, for every pound invested in public health, 14 are returned to the overall health and social economy,” she argued.
Other studies point out that for every $1 invested in health promotion, $2 to $4 is saved in future health costs, and for every $1 invested in water, sanitation and hygiene (WASH), up to $7 is saved in health expenditures.
Hence, warned Eijkemans, "cuts in public health budgets represent a false economy. They are likely to generate billions in additional costs for health services and the economy as a whole."
Eijkemans considered that is necessary to take a broader and more holistic approach to health. She noted that 20% of people's health is linked to medical care and attention and another 30% is related to personal habits, such as diet or physical exercise. “However, up to 40% is related to social determinants, such as employment, housing, income level or education, and 10% to factors related to the environment in which people live and work.” Against this backdrop, there is a key question to ask: “Why cure people and send them back to the situation that made them sick?” she reflected.
The Federal Reserve Bank of New York webinar focused on investment strategies to address the social determinants of health to improve the health and economic outcomes of communities. Topics covered included strategies for developing infrastructure to improve health, mobility and sustainability, municipal financing, outcome monitoring, and examples of communities leveraging their assets.
People in situations of vulnerability, at the core
The Director of the Department of Social and Environmental Determinants for Health Equity mentioned that addressing social determinants is especially relevant in the Region of the Americas, the most unequal in the world. “This explains, for example, the enormous impact of the Covid-19 pandemic, when the Region was for many months the epicenter due to health inequities.”
“Now we are facing the triple planetary crisis (climate change, biodiversity loss and pollution) and the analysis repeats itself: those who contribute the least to the environmental crisis are the most affected, vulnerable territories such as small island states, and within each country, people and communities in situations of vulnerability will receive the greatest impact, so that climate change will aggravate inequities,” she said.
Eijkemans mentioned several of PAHO's tools, projects and strategies in this regard, such as the Strategy and Plan of Action on Health Promotion within the Context of the Sustainable Development Goals 2019-2030, the Healthy Municipalities, Cities and Communities Movement, the network of experts on intersectoral work, the Policy for Recovering Progress toward the Sustainable Development Goals with Equity through Action on the Social Determinants of Health and Intersectoral Work, or the Policy for Strengthening Equity-Oriented Health Sector Action on Climate Change and Health.
