**4. What are the factors that influence people's health status?**

Scientific work on health inequalities has exponentially increased over the last five decades and particularly since the establishment of the World Health Organization (WHO)'s Commission on Social Determinants of Health (CSDH) in 2005. The CSDH approach has focused on the Social Determinants of Health (SDH) perspective, providing an alternative for the approaches limited only to the medical-health aspect and individual behaviors [26]. As a matter of fact, the medical-health approach had always focused on improving health care quality and addressing unhealthy behaviors (e.g., incorrect life style) to achieve greater health equality. Thus, individuals have been considered as responsible for their own health, and the main strategy for preventing disease has been focused on the promotion of correct life style and on behavioral modifications (e.g., smoking cessation, decreasing salt and fat intake, and reducing sedentary lifestyle) [21, 27]. Encouraging better individual behavior is a well-established approach to health promotion, but the evidence suggests that these interventions may have limited effect without to tackle health inequalities [21]. Conversely, an incorrect lifestyle

could be a response to social breakdown and a mirage to escape from social adversity and stress. Several studies have shown that alcohol dependence, illicit drug use, and cigarette smoking are all closely associated with markers of social and economic disadvantage [28, 29]. The WHO introduced a new approach for public health intervention that recommended more concern toward social policies and social determinants of health. According to the suggestions of the WHO [10, 30], different countries in the world (especially European countries) are focusing their health policy interventions both on promoting better lifestyles and addressing the root causes of health inequalities.
