“The ambulance waiting at the bottom of the cliff”


Daniels, Kennedy and Kawachi, writing about the importance of addressing social determinants of health in their 2000 essay, “Justice is good for our health”:

Health is produced not merely by having access to medical prevention and treatment, but also, to a measurably greater extent, by the cumulative experience of social conditions over the course of one’s life. By the time a sixty-year-old heart attack victim arrives at the emergency room, bodily insults have accumulated over a lifetime. For such a person, medical care is, figuratively speaking, “the ambulance waiting at the bottom of the cliff.” Much contemporary discussion about reducing health inequalities by increasing access to medical care misses this point. We should be looking as well to improve social conditions–such as access to basic education, levels of material deprivation, a healthy workplace environment, and equality of political participation–that help to determine the health of societies.

Read the whole essay here.


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