Abstract
Although social gradients in morbidity and mortality from scrofula rickets and scarlet fever were noticed in England as early as 1845 current understanding of the relationship between and ill health is still evolving. A detailed examination of the social determinants of health is the current focus of a World Health Organization Commission and a global agenda that addresses the overlapping vulnerabilities of social exclusion and health recently has been articulated in the United Nations Millennium Development Goals (MDG) framework. Sub-Saharan Africa remains the area of the world at greatest risk of failing to meet any MDG targets. Some experts suggest that conditions of extreme deprivation characterizing much of the region create poverty traps that limit access to proven interventions and constrain potential gains in employment income food shelter and education carrying dire immediate and longer-term health consequences. The interdependence of health and development might seem obvious but cross-sectoral experience on how and where to intervene remains limited. (excerpt)
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