Nice Primer on Social Determinants: Richard Wilkinson’s TEDTalk

From the Website of my namesake, this TEDtalk by Richard Wilkinson does a nice job of showing the impact of social gradients on health and society, regardless of the overall development stage of the society.

He refers to “economic inequality,” a lot of work, though discusses this as “social AND economic differences.” See: Now Reading: “Behavior is not the whole story” – Social and Economic Determinants are where Health Disparity Begins.

This is very relevant to what’s being discovered (and changed, post coming up) in the rights afforded to human beings in the United States.

I think I’m looking and talking about the psychosocial effects of inequality. More to do with feelings of superiority and inferiority, of being valued and devalued, respected and disrespected…..The social-evaluative judgments increase, the fear of those social-evaluative judgments…tasks that included social-evaluative threat — threats to self-esteem or social status in which others can negatively judge your performance. Those kind of stresses have a very particular effect on the physiology of stress.

Also, this is not to suggest that the only solution, especially from the health care system, is income redistribution. Take a look at this recent quote from Michael Marmot.


Oh! And I forgot to thank reader Kathleen Furtado for exposing this to me. Thank you Kathleen!


First, I think Richard Wilkinson could expound on any topic and he’d sound credible — what a voice and accent!

Second, I heard similar data from Stephen Bezruchka at Health Foo last year. For those who want to dig in, please see:

What I learned at Health Foo (includes a summary of Bezruchka’s talk)

Also: Bezruchka’s TEDx talk

Third, the book I’m currently reading is yet another illustration of how social inequities have a devastating effect on health:

Will to Live: AIDS Therapies and the Politics of Survival, by João Biehl

Don’t miss the breathtaking portraits by Torben Eskerod:

It won the 2008 Diana Forsythe Prize from the American Anthropological Association (you may recall the few hundred times I’ve quoted her immortal wisdom: “Whose assumptions and whose point of view are inscribed in the design of this tool?”)

And because I always want to know the ingredients of my Kool-Aid, and I know you do too, here is NEJM’s review of the book:

One more thing to share, particularly with you, Ted, since you are someone who embraces serendipity: I only know about this book because of my son’s Little League game! A Georgetown student had been walking by, saw the game and stopped to snap some shots for his photography class (the assignment was something like “capture live action in the community”). He put down his book near me and (shocker) I struck up a conversation with him about it.

@SusannahFox Susannah,

It is always a good blogging day when I write something that engages you. I watched the TEDxTalk and reviewed the photo stories (the book will take a little longer…).

I definitely feel there is a new awakening about the limits of depending on individual behavior change, in a developmentally appropriate way. It strikes me that you’ve been bringing this idea into your work for sometime, as you explore different uses of technology by people, tabulated by aspects related to social and economic gradient.

Love serendipity, of little league, of social media, of a walk instead of a car ride, does the Georgetown student’s professor know that he’s teaching you and I right now? 🙂


@Kathleen Furtado Thank you Kathleen – I loved it too. I think reduction of inequality is happening right now in your State (Washington, to be specific, if that’s where you still are), and will be signed into law on February 13, 2012 :).

I bring this up because reduction of inequality is not always “income redistribution” – it can be anything that creates a fair society, and in the US, we don’t have the option to do many of the things the Europeans do (PS the link didn’t function but I can guess what it was referring to).

If you saw the CEO of JcPenny recently, he said that they are standing by their choice of spokesperson because they want to support fairness. That’s reduction of inequality.

For health care, I think there are things to be said about collaborating with all of the other places in society that can influence fairness, from policy (as you are seeing in Washington State), to the industries that feed us and finance our lives. I think this is where our creativity comes in. Thoughts?

Thanks for the awesome link and thinking,


Ted Eytan, MD