Yes, says Martin Tobias’s must-read commentary in The Lancet.
The commentary cites a paper in the same issue arguing that low social rank, meaning “powerless to determine your own destiny, deprived of material resources, and limited in the opportunities open to you,” has a profound effect on lifestyle and life chances.
Its authors base these views on a study of 1·7 million adults followed up for mortality (all cause and by cause) for an average of 13 years.Even with use of a crude categorisation of social rank based on occupation (professional, intermediate, and unskilled), the study was able to quantify the social gradient in mortality: an approximately 20% increase in risk per unit decrease in rank.
Tobias’ commentary recommends evidence-based strategies to minimize the impact of social hierarchy on health:
Invest in children
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Early childhood development enrichment programs
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Intensive parent support (home visiting) programs
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Enrollment of all children in early childhood education
Get the welfare mix right
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Regulate markets as necessary
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Implement income transfer policies that redistribute resources (ie, progressive tax and benefit regimes)
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Optimize balance between targeted and universal social protection policies through benefit design that minimizes both undercoverage and leakage
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Eliminate child poverty through monetary and non-monetary support for families with dependent children
Provide a safety net
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Provide income support or tax credits
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Provide social housing
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Subsidize childcare
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Provide free access to health care (especially preventive services)
Implement active labor market policies
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Provide job enrichment programs
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Democratize the workplace (involve employees in decision making)
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Provide career development and on-the-job training
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Provide fair financial compensation and intrinsic rewards
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Promote job security
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Discourage casualization of the workforce
Strengthen local communities
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Foster regional economic development
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Promote community development and empowerment
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Encourage civic participation
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Create mixed communities with health-enhancing facilities
Provide wrap-around services for the multiply disadvantaged
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Coordinate services across government and NGOs
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Provide intensive case management when necessary
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Foster engagement of the targeted families and individuals
Promote healthy lifestyles
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Strengthen tobacco control and addiction services
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Improve the diet of poor families (eg, through subsidizing fruit and vegetables, community gardens, purchasing co-ops, school meals)
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Provide green space and subsidized sport and recreation facilities
Ensure universal access to high quality primary health care
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Subsidize practices serving high need populations
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Provide additional nursing and social worker support for practices in disadvantaged areas
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Assist patients with clinic transport and childcare
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Provide services free at point of use
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Provide conditional cash transfers (to increase demand for clinical preventive services)
The paper is open access. Spread it around. Pick the recommendation you think most important, and get to work!