A Tale of Two Enthusiasms

Norkopping, Sweden 7 May 2014.

Two medical students wrote to me to say that they heard some WHO people say: Social Determinants? It is everything and nothing. My thought: Ah! That familiar world-weary cynicism, makes me feel all is normal with the world. Why be enthusiastic when you could use your cynicism to justify business as usual, or worse.

 By contrast, I have just been to Sweden – the second of several planned trips to Nordic countries this year. It was put to me by a Swedish colleague that we, the Marmot Review team, have become a brand in Sweden, not to mention enthusiasm for social determinants in other Nordic countries. Of course, one could argue that, of any group of countries, the Nordic countries are least in need. They are already doing it, and have relatively narrow health inequalities. Still, our conclusion at the end of the European Review was: do something, do more, do better. The Swedes want to do better.

We have had the Commission for a socially sustainable Malmo. There is a similar Commission taking place in VastGotaland, centred on Gothenberg. And I was in Norkopping, now, to speak at a meeting where the draft recommendations of the Ostergotland Commission were being aired. The conclusions continue the tradition of Closing the Gap with recommendations taking in the life course, and dealing with the causes of the causes. One special feature of the Ostergotland Commission is that it was not just set up by a political decision, but politicians are part of it. The aim is that having been part of the process, the local and regional politicians will be enthusiastic about implementation. Margareta Kristenson, Professor of Social Medicine at Linkoping University said that they considered two possibilities: not having the politicians involved would allow them to be more radical; having politicians as members might mean that they compromised on their conclusions. In the end, they decided that the advantage of having the people whose job would be implementation as part of the process was worth it. Looking at their draft recommendations, I would say that there is not too much evidence of compromise.

When we began the Commission on Social Determinants of Health, we said we wanted to foster a social movement. It is not being taken forward by cynics who say that ‘social determinants is everything and nothing’. As I waited for the Stockholm train at the Railway station at Kolmarden – no I hadn’t heard of it either, but its near Norkopping if that helps – I thought: could I have imagined in my wildest dreams that the social movement for health equity would be thriving in Kolmarden in Sweden.