Search Results

Clustering of Disadvantage and Empirical Research

Jonathan Wolff and Avner De-Shalit

in Disadvantage

The previous chapters demonstrated that the issue of identifying the least advantaged reduces to the question of whether clustering of disadvantage can be identified among the ‘high-weight ... More

The previous chapters demonstrated that the issue of identifying the least advantaged reduces to the question of whether clustering of disadvantage can be identified among the ‘high-weight functionings’ identified in Chapter 5. It is argued that a series of empirical studies confirm that such clustering exists. In particular, work on the social determinants of health by Marmot and Wilkinson suggests that there is significant clustering of the relevant disadvantages. These results are reinforced by Klinenberg's work on the Chicago heatwave of 1985.Less

Social Epidemiologic Alternatives: Sociopolitical and Psychosocial Frameworks

Nancy Krieger

in Epidemiology and the People’s Health: Theory and Context

Chapter 6 traces the historical development and explicates the key constructs of the major theoretical alternatives to biomedical and lifestyle approaches: the sociopolitical and psychosocial ... More

Chapter 6 traces the historical development and explicates the key constructs of the major theoretical alternatives to biomedical and lifestyle approaches: the sociopolitical and psychosocial frameworks that comprise the main theoretical trends in social epidemiology. A central argument is that although these two trends are united in their view that societal context shapes population health and is responsible for health inequities, they nevertheless differ in important ways. The sociopolitical theories focus principally on power, politics, economics, and rights as key societal determinants of health, whereas the psychosocial theories emphasize psychologically-mediated determinants. Sociopolitical theories discussed include: social production of disease, political economy of health, social determinants of health, population health, fundamental cause, Latin American social medicine, and health and human rights. Analysis of the psychosocial theories traces their links to psychosomatic medicine, stress research, and the biopsychosocial model, and also examines their approaches to conceptualizing social hierarchy, allostasis, and allostatic load.Less

Justice, Capability, and Health Policy

Jennifer Prah Ruger

in Health and Social Justice

This chapter provides a workable operationalization of health capabilities, and seeks a shared standard of health based on the demands of social justice and the right to health in terms of health ... More

This chapter provides a workable operationalization of health capabilities, and seeks a shared standard of health based on the demands of social justice and the right to health in terms of health equity. The health capability paradigm offers a trans‐positional conception of health that reflects the ‘view from everywhere’. This chapter delineates the relationship between health capabilities, health functionings, health needs and health agency, introducing shortfall in equality —— deviations of individuals or groups from a standard —— as a means for judging public policies affecting health. It emphasizes that although many factors influence health, health policy is one of the most important determinants; thus there is need for efficiency in health policy, and for joint clinical and economic solutions to achieve optimal levels of health and reduce inequalities in individuals' capabilities to be healthy. It argues for a differential allocation of resources to mitigate shortfall inequality. It critically analyzes the ethics of the social determinants of health and surveys and responds to criticisms of the capability approach.Less

Policy change and the social determinants of health

Toba Bryant

in Health Promotion and the Policy Process

Health inequalities are directly related to how governments develop and implement public policy. Much of the academic literature and public policy institutes recommend that governments implement ... More

Health inequalities are directly related to how governments develop and implement public policy. Much of the academic literature and public policy institutes recommend that governments implement public policies to strengthen the social determinants of health (SDOH). Canadian governments, however, have been resistant to the SDOH concept. This chapter argues that critical approaches to public policy can identify barriers to the uptake of SDOH in public policy and to achieve healthy public policy. The conditions and barriers to developing public policy to address the social determinants of health are identified. Specific attention considers the forces that influence the framing of SDOH. Jurisdictions that have developed SDOH supporting public policies have done so because the general citizenry has been able to influence its policymaking agenda. The focus will be on the current political context in North America with lessons for elsewhere.Less

Reflections on Global Monitoring of Social Determinants of Health and Health Equity

Ritu Sadana

in Inequalities in Health: Concepts, Measures, and Ethics

The chapter reflects on the policy discourses and recommendations on ways to enhance global monitoring of social determinants of health and health equity, around the time of the Commission on Social ... More

The chapter reflects on the policy discourses and recommendations on ways to enhance global monitoring of social determinants of health and health equity, around the time of the Commission on Social Determinants of Health. Section 1 discusses the distinction between health inequalities and health inequities, with health inequities reflecting social injustice in broader living conditions (reflecting systematic social, political, historical, economic and environmental factors), and being masked by national or population averages. The Commission on Social Determinants of Health made clear that since health inequities are unfair and potentially avoidable, action to address the causes warrant support by international agencies, governments, and other stakeholders. These discourses are entering international policy dialogues and examples from WHO and other entities are provided. Also outlined is the development of an approach towards global monitoring of social determinants of health and health equity, during the time of the Commission. This included agreeing on a conceptual framework to illustrate the pathways from social determinants to the unfair distribution of health, and recommending a set of indicators based on existing data. Section 2 provides examples of sustained interest in monitoring of social determinants of health and health equity at different levels. It makes the case that monitoring efforts could offer a global public good, that can serve the health sector and beyond. This chapter is not intended to be representative of the very complex, rich and important overall efforts of the Commission on Social Determinants of Health or of the World Health Organization.Less

Reflections on the UK’s legacy of health inequalities research and policy from a North American perspective

Dennis Raphael and Toba Bryant

in Health Inequalities: Critical Perspectives

This chapter reflects on the insights UK research and policy experiences have offered those working to address health inequalities in Canada and the USA. Written by leading Canadian experts on the ... More

This chapter reflects on the insights UK research and policy experiences have offered those working to address health inequalities in Canada and the USA. Written by leading Canadian experts on the social determinants of health, it argues that the UK has provided researchers and policymakers with numerous insights into how to conceptualize, research, and act to reduce health inequalities, whilst also summarizing some of the key contributions that Canadian and American researchers have made to health inequalities debates. The authors argue that, whilst policy developments in the USA have been extremely limited when it comes to health inequalities, there are reasons to be more optimistic about the possibilities for addressing health inequalities and the social determinants of health in Canada.Less

The life course, inequalities and mental health in later life

Alisoun Milne

in Mental Health in Later Life: Taking a Life Course Approach

Chapter 3 explores the contribution of the lifecourse approach and social gerontology to understanding mental health outcomes in later life. It also explores the role played by health and social ... More

Chapter 3 explores the contribution of the lifecourse approach and social gerontology to understanding mental health outcomes in later life. It also explores the role played by health and social inequalities. By bringing these perspectives together the Chapter makes visible the ways in which lifecourse inequality and adversity e.g. childhood abuse, create and/or amplify risks to mental health in later life. It also exposes the embedded and structural nature of causative mechanisms. Health inequalities have profound implications for mental health. People from disadvantaged socioeconomic backgrounds suffer disproportionately from common mental disorders, such as depression, across the whole lifecourse. They are also exposed to higher levels of chronic psychosocial stress which, independently and additively, undermines mental wellbeing. These effects are cumulative over the longer term and in more unequal societies; also by exposure to discrimination and oppression. These arguments challenge the dominance of the ‘inevitable decline’ model of ageing exposing a more nuanced complex set of intersecting risks to mental health that are structurally located and socially produced. The role of policy in addressing health inequalities and their social determinants was a key dimension of mental health policy until 2011; since then it has become increasingly uncoupled from the policy agenda.Less

Justice, Care, and Health Care

Daniel Engster

in Justice, Care, and the Welfare State

Health care has traditionally been justified in terms of its contribution to good health, but recent developments (research into the social determinants of health, population aging, and cost ... More

Health care has traditionally been justified in terms of its contribution to good health, but recent developments (research into the social determinants of health, population aging, and cost concerns) have questioned the validity of this justification. This chapter outlines an alternative theory of health care justice that explains why health care has special moral importance, shows how we can adapt health care to better meet the needs of older populations, and identifies some key strategies for rationing public health care resources. It is argued that multi-payer systems perform better than both mixed-private and single-payer systems. The care-based theory of health care justice outlined here provides a holistic paradigm for thinking about health and health care justice. From the perspective of care ethics, health care is special not so much because of its ability to promote good health as because of its ability to deliver everyday good medical care to individuals.Less

Justice, Evidence, and Interdisciplinary Health Inequalities Research

Nicholas B. King

in Understanding Health Inequalities and Justice: Bridging Perspectives for New Conversations

This chapter examines the interplay between normative judgments and empirical research. Using a case study of recent work on the social determinants of health, the author argues that three domains ... More

This chapter examines the interplay between normative judgments and empirical research. Using a case study of recent work on the social determinants of health, the author argues that three domains that are normally thought of as conceptually and disciplinarily independent—epistemology, scientific methodology, and normative judgment—are in fact closely intertwined. When considering issues related to health inequalities and social justice, keeping these domains separate leads to poor science, poor theorizing, and, ultimately, poor policy choices. The author identifies three problems with the claim that in order to reduce health inequalities and improve population health, we are morally compelled to address the social determinants of health, through interventions that redistribute social or economic resources in a more fair or just manner. The problems are (1) assuming that data are the neutral products of objective scientific investigations; (2) misunderstanding causality and counterfactual reasoning; and (3) blind belief in the consonance of the good.Less

Introduction Holism against Reductionism

Joseph E. Davis

in To Fix or to Heal: Patient Care, Public Health, and the Limits of Biomedicine

The Introduction sets out the major themes of the book. These include medicine’s role in the moral and cultural agendas of contemporary society, challenges to the biomedical model represented by new ... More

The Introduction sets out the major themes of the book. These include medicine’s role in the moral and cultural agendas of contemporary society, challenges to the biomedical model represented by new regimes of disease and disorder, and the limitations of principlist bioethics for moving in a more holistic direction. In the working definition of the book, “reductionism” suggests a mechanistic and narrowly somatic understanding of disease, monocausal theories of disease, and an exclusive preoccupation with cure to the neglect of prevention. Meanwhile, “holism” refers to a contextual understanding of disease causation, intervention, or practice. A systemic concern with the whole organism, a focus on the interconnected effects of the larger environment, and ethical concerns with the clinical encounter, can all be characterized as holistic. The Introduction situates the struggle between these perspectives in historical context, and calls for a renewed focus on the social determinants of health and a more holistic ethical perspective.Less

Conclusion: Religion’s Role as a Social Determinant of Twenty-First-Century Health: Perspectives from the Disciplines

Paul Root Wolpe, Walter Burnett, and Ellen Idler

in Religion as a Social Determinant of Public Health

The concluding chapter frames religion’s role as a social determinant of health with perspectives from ethics and policy. The chapter first argues that the mission of public health is to conduct ... More

The concluding chapter frames religion’s role as a social determinant of health with perspectives from ethics and policy. The chapter first argues that the mission of public health is to conduct research and act on it to improve the health of society; it is an ethical imperative to include religious communities as fundamental parts of social life. The chapter then, arguing from a policy perspective, asserts that taking religion into account as a social determinant of health will increase social organization to promote healthy behaviors, facilitate common cause for social change, and increase the sophistication of health research. The chapter then concludes that expanding the social determinants paradigm will reveal that religion acts pervasively to determine public health, both upstream, where it interacts with other macrosocial economic and political determinants, and downstream, where its powerful influence on health-related behaviors is felt in the daily lives of billions of people.Less

Mauli Ola: Pathways to Optimal Kanaka ‘Ōiwi Health

Joseph Keawe‘aimoku Kaholokula

Winona K. Mesiona Lee and Mele A. Look (eds)

in Ho'i Hou Ka Mauli Ola: Pathways to Native Hawaiian Health

This essay explores the social and cultural determinants of Kanaka ʻŌiwi (Native Hawaiian) health and the pathways to Mauli Ola (optimal health and wellbeing). Future opportunities for enhancing ... More

This essay explores the social and cultural determinants of Kanaka ʻŌiwi (Native Hawaiian) health and the pathways to Mauli Ola (optimal health and wellbeing). Future opportunities for enhancing Mauli Ola explored are the demographic changes in the Kanaka ʻŌiwi population, continuing cultural revitalization efforts, participation in the larger society, and self-determination and the larger international Indigenous movement. Several shared Kanaka ʻŌiwi aspirations important to Mauli Ola are highlighted to include supporting a strong Kanaka ʻŌiwi identity and space, strengthening ‘ohana (family) relations, and ensuring the practice of mālama ‘āina and aloha ‘āina.Less

Digitized Health Promotion: Risk and Personal Responsibility for Health and Illness in the Web 2.0 Era

Deborah Lupton

in To Fix or to Heal: Patient Care, Public Health, and the Limits of Biomedicine

This chapter explores the use of digital health technologies in health promotion endeavors. This “digitized health promotion” is the latest stage in the trajectory of health promotion ideology and ... More

This chapter explores the use of digital health technologies in health promotion endeavors. This “digitized health promotion” is the latest stage in the trajectory of health promotion ideology and practice over the past four decades in wealthy Anglophone nations. Lupton argues that over this period the individualistic approach to good health commonly espoused in medicine and public health was challenged by advocates arguing for a greater focus on social justice and social epidemiology. The individualistic approach to health promotion never disappeared, however, and has gathered momentum in the current economic, political, and technological climate. While many health promotion workers still champion the ideals of “health for all,” public health policy in the context of digitized health promotion has begun to return to emphasizing personal responsibility for health.Less

Fair Society Healthy Lives

Michael Marmot

in Inequalities in Health: Concepts, Measures, and Ethics

Inequalities in health refer to the systematic differences in health among social groups. In rich countries, and increasingly in low and middle income countries, health follows a social gradient ... More

Inequalities in health refer to the systematic differences in health among social groups. In rich countries, and increasingly in low and middle income countries, health follows a social gradient progressively worse the lower people are on the social scale. While the causal direction between wealth and health may run both ways, there is strong evidence that social conditions have powerful influence in generating these health inequalities. This body of evidence has allowed us to formulate recommendations to government and others on means to reduce health inequalities. The reason for action to reduce such health inequalities is a moral one, not primarily economic. Health should be seen as a value in itself not only as a means to some other end, such as wealth of individuals or societies. We should have two societal goals: improve average health and reduce inequalities. Both are valuable and should not be traded off against each other.Less

The accidental logic of health policy in Australia

Fran Baum and Judith Dwyer

in Australian public policy: Progressive ideas in the neo-liberal ascendency

This chapter argues that contemporary health policy in Australia is shaped by its response to three fundamental challenges: how to maximise health outcomes; how to ensure equity in access to health ... More

This chapter argues that contemporary health policy in Australia is shaped by its response to three fundamental challenges: how to maximise health outcomes; how to ensure equity in access to health care; and how to operate an effective health care delivery system within constrained resources. The chapter describes how health policy continues to be conducted as a ‘strife of interests’, involving powerful professional and industry groups. It argues that Medicare (universal public health insurance scheme) remains as one of the strengths of the health system, providing affordable and effective care for most Australians. Health inequities remain and these reflect the distribution of the social determinants of health, including access to health care. For the future special efforts need to be made to close the gap in life expectancy between Indigenous and non-Indigenous Australians, strengthen primary health care and reshape health care delivery so that it can be sustainable, efficient and effective.Less

Addressing health inequalities: building on Peter Townsend’s legacy

Margaret Whitehead

in Fighting poverty, inequality and injustice: A manifesto inspired by Peter Townsend

This chapter considers health inequalities, an area in which Peter used his science and his art to press for more effective action. It notes that far from allowing the Conservative government at the ... More

This chapter considers health inequalities, an area in which Peter used his science and his art to press for more effective action. It notes that far from allowing the Conservative government at the time to bury the findings of the Black Report on health inequalities, which focused on the social determinants of health, Peter's efforts turned it into a Penguin best-seller with three editions. It also draws on Peter's work to discuss both the nature of the national and global challenges that remain, as well as considering the link between poverty and health.Less

Introduction: social work’s contribution to tackling lesbian, gay, bisexual and trans health inequalities

Julie Fish and Kate Karban

in Lesbian, gay, bisexual and trans health inequalities: International perspectives in social work

Social work is explicitly committed to health as a fundamental human right and a matter of social justice. Mitigating the impact of social disadvantage is a core concern of social work around the ... More

Social work is explicitly committed to health as a fundamental human right and a matter of social justice. Mitigating the impact of social disadvantage is a core concern of social work around the globe; supporting people to manage the tasks of daily living and the maintenance of their support networks contributes to their social care outcomes and their health. But it is not only the material conditions of people’s lives which influence their health and well-being, the effects of discrimination and oppression arising from people’s social position, including their gender, ethnicity, age or disability is recognised as having a profound impact on their quality of life. Discrimination limits the lives of LGBT people and contributes to unequal health outcomes; the chapter explores how social work can address LGBT health inequalities and promote positive social care outcomes. The chapter considers six conceptual frameworks commonly used to theorise health inequalities. Taking each in turn, we examine the implications of the approach in understanding LGBT health inequalities. In conclusion, we discuss the nature, role and purpose of social work intervention with LGBT people and illustrate how social work contributes to the six Marmot policy objectives and to tackling LGBT health inequalities.Less

Social Forces and Their Impact on Health

Joia S. Mukherjee

in An Introduction to Global Health Delivery

This chapter focuses on the social determinants of health. The phrase—the social determinants of health—is used to describe the factors and forces in society that cause ill health and premature ... More

This chapter focuses on the social determinants of health. The phrase—the social determinants of health—is used to describe the factors and forces in society that cause ill health and premature death. To achieve health equity, it is important to understand the impact of social determinants and work to mitigate their adverse health effects. The practice of social medicine uses a biosocial approach that merges biomedical science with social analysis to design programs that strive for health equity. Because of the historical and geopolitical forces that have shaped global inequities, social medicine and a biosocial approach are important in global health and health equity and are addressed in this chapter.Less

A sick city in a sick country

David Baruffati, Mhairi Mackenzie, David Walsh, and Bruce Whyte

in Transforming Glasgow: Beyond the Post-Industrial City

The comparatively poor contemporary health profiles of Scotland and, in particular, Glasgow have become widely known. Drawing on a body of research compiled by the Glasgow Centre for Population ... More

The comparatively poor contemporary health profiles of Scotland and, in particular, Glasgow have become widely known. Drawing on a body of research compiled by the Glasgow Centre for Population Health, this chapter provides a detailed examination of the health profiles of these populations as they have been shaped over time. The chapter begins by tracing their historical development in their UK and European context, before turning to examine the political, social and economic causal factors and processes which have, over time, contributed to the particularly poor health outcomes experienced in Glasgow. Building on this knowledge, the chapter draws to a close by exploring the potential future health trajectory of the city’s population. Glasgow provides a potent case for other cities and countries as they consider the ways in which politics and policy come to shape health, and health inequalities, across their populations.Less

Promoting Social Justice Through Education in Public Health

Robert S. Lawrence

in Social Injustice and Public Health

This chapter explores how to promote social justice through education programs for students in schools of public health, medical school departments of community and preventive medicine, and ... More

This chapter explores how to promote social justice through education programs for students in schools of public health, medical school departments of community and preventive medicine, and elsewhere. It also examines how education can equip public health practitioners, researchers, and educators with a social justice perspective that will guide their future work. Two major developments provide crucial information and values for developing and implementing social justice curricula: human rights law and progress in developing analyses of the social determinants of health. This chapter covers principles of social justice, the integration of human rights with public health, and a historical context for the evolution of related developments. The chapter describes examples of the introduction of social justice into public health curricula. The chapter concludes with an agenda for action. A text box contains the International Declaration of Health Rights. A second text box describes the Simmons Master of Public Health in Health Equity program.Less