Strategies to intervene on social determinants of infectious diseases.

Systematic health inequalities exist in all European countries today. Individuals with lower socio-economic status suffer disproportionally from adverse health outcomes. While this is widely accepted for chronic diseases, a literature review covering the years 1999-2010 reveals that infectious diseases are also distributed unevenly throughout society, with vulnerable groups bearing a disproportionate burden. This burden is not restricted to a few 'signature infections of social determinants' such as tuberculosis or human immunodeficiency virus (HIV) infections, but also a wide array of other infectious diseases. Tremendous advances in public health over the last century have reduced the absolute magnitude of inequalities but relative differences remain. In order to explore the underlying reasons for such persistent inequalities in Europe, I examined interventions targeting social determinants of infectious diseases: interventions on social determinants tend to focus on chronic diseases rather than infectious diseases, and interventions for these mainly focus on HIV/AIDS or other sexually transmitted infections. Thus, there seems to be a need to intervene on inequalities in infectious diseases but ideally with a comprehensive public health approach. Three intervention strategies are discussed: population-at-risk, population, and vulnerable population approaches. Strengths and weaknesses of these options are illustrated.