Friday, 16 September 2011
Determinants of Health: Original versus Social - both have value. Where is the debate?
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1994 brought the landmark document from the Council of Ministers of Health on Strategies for Population Health Investing in the Health of Canadians as prepared by the Advisory Committee on Population Health. http://www.phac-aspc.gc.ca/ph-sp/pdf/strateg-eng.pdf . It laid the foundation for the eventual 12 standard determinants of health (the original document referenced only 9 determinants and has since added gender, culture and social environments and modified wording)
Income and Social Status
Social Support Networks
Education and Literacy
Personal Health Practices and Coping Skills
Healthy Child Development
Biology and Genetic Endowment
The rhetoric has stood the test of time, and many of these are now integral to the discourse and approaches used in the field born by the terms of Population Health. The genesis of the document can be found in a 1991 document by Fraser Mustard and John Frank named “The Determinants of Health” (I have a republication in a 1994 Western Geographical Series Vol 29 on The Determinants of Population Health, but no link if anybody has a link, please send it to me).
There has been a migration to using the term “Social Determinants of Health”. While the discourse is similar, the social determinants are a different list and vary depending on where they are accessed. The concept was founded in 1999 by Sir Michael Marmot who has since led the WHO review on the Social Determinants and Health that was released in 2009. It has been championed in Canada by Ron Labonte
social inclusion and exclusion
employment and job security
contribution of the social economy
early childhood education and care
Both lists have overlapping issue. The main difference is that several of the determinants items are “non-modifiable” such as gender, genetics and age, and the influence of the physical environment is lacking. Both lists stress that health is more than disease and certainly more than the health systems ability to reduce the impact of dis-ease. The determinants list includes health services for which most estimates will say contribute to about ¼ of our wellbeing at most. The original statement about Health Services in the report is worth repeating “particularly those designed to maintain and promote health, and prevent disease.” The melding of the two determinant lists has led to much of the current focus on reducing inequities. When the discussion uses the term “social determinants of health”, check and see which list as actually being referenced. The intent may be similar, but the basics and language are actually dissimilar.