SDOH-Listserv Bulletin No. 1, January 26, 2004
Greetings and Welcome to the Official Kick-off of the Social Determinants
of Health Listserv at the School of Health Policy and Management at York
University in Toronto Canada
This rather long Bulletin is available as a Word File at
http://quartz.atkinson.yorku.ca/QuickPlace/draphael/Main.nsf/
Please forward this Bulletin to potentially interested parties.
Subscription information at the bottom.
A. THE GOALS OF THE LIST-SERVE CONFERENCE ARE [BUT NOT LIMITED] TO:
1. Provide the latest information on scholarship on social determinants
of health
There is a wealth of information about SDOH available in scholarly papers
and numerous reports, but this information is rarely a) integrated into
general health policy or b) provided to the public. As an illustration, I
have the Google search engine inform me when any of their 4500 news sources
contain the phrase "social determinants." In the last two months there has
been a single hit: Canada's NDP (social democratic) leader Jack Layton used
the term in a news release discussing why the Canadian Strategy for
HIV/AIDS falls short of what is required.
Part of the purpose of the listserv is to help us understand why this is
the case and to help rectify this situation. Many of us in North America
and probably elsewhere have thought long and hard about means of rectifying
this with some ? if limited -- success. We need to share these thoughts
and offer some solutions.
2. Explore the implications of these conditions for the health of
citizens
Enough evidence exists as to what happens when economic and social
conditions deteriorate. This literature is found in diverse literatures:
social development, child and family welfare, urban studies, justice and
criminology, population health, political economy, and others. These need
to be made available to policy makers, the public, and others concerned
with health.
Critical analyses of the forces driving these developments need to be
undertaken and presented. Policymakers and health officials in many
jurisdictions are well aware of the effects, but lack critical
understanding of how political and economic forces drive these
developments. Some have argued that the social determinants of health
debate is really about the quality and survival of the welfare state. Yes,
even the USA has a welfare state: I grew up in it when it was a lot
stronger, but the basic concept remains relevant to understanding these
issues.
3. Provide support for those of us attempting to strengthen these social
determinants of health in our local jurisdictions.
While attempts to have social determinants of health made part of health
policy remains a daunting and frustrating task for many, there are examples
of success and/or progress.
The Scandinavian nations have explicitly recognized and acted upon these
principles. See http://www.fhi.se/pdf/roll_eng.pdf or
http://www.stm.fi/Resource.phx/eng/subjt/socpr/index.htx.
In the USA the San Francisco public health authorities
http://www.dph.sf.ca.us/PHP/php.htm
and the Minnesota http://www.health.state.mn.us/divs/chs/phg/intro.html
and Washington State http://www.doh.wa.gov/HWS/doc/RPF/RPF_Soc.doc
health departments have recognized their importance. The Centers for
Disease Control and Prevention has a SDOH initiative
http://www.cdc.gov/epo/ads/newsletters/adsnew-1-workgroups.htm
In Australia, a key component of the Queensland Public Health Forum is
addressing the social determinants of health
http://www.health.qld.gov.au/QPHF/Documents/StrategicDirections.PDF.
In New South Wales, the Report of the New South Wales Chief Health Officer
http://www.health.nsw.gov.au/public-health/chorep/soc/soc_intro.htm
emphasizes their importance. Tell us about other examples of health
officials addressing these issues.
In Canada, Health Canada continues to develop the implications of a social
determinants of health approach. In Ontario, the Waterloo Region Health
Unit has moved on such an agenda. The Montreal Region Public Health is a
pioneer in addressing issues of social inequalities associated with the
social determinants of health -- see especially the annual reports of the
Medical Officer of Health -
http://www.santepub-mtl.qc.ca/english/index.html.
Significant barriers exist. The March 1993 edition of the journal Policy
Options has four articles that address the current situation in Canada
http://www.irpp.org/po/ and identify barriers to implementing a SDOH policy
approach.
Many more examples of action exist around the world and need to be
celebrated and shared. Tell us about these!
B. WHERE ITS HAPPENING! ? A Few Selected Examples
1. http://www.fhi.se/pdf/roll_eng.pdf
The National Institute of Public Health (2002). Sweden's New Public-Health
Policy.
This document provides an excellent example of a social determinants of
health approach to national health policy. The website
http://www.fhi.se/english/eng_summaries.asp provides other examples of
Swedish health policy. There is a reason that the Swedes are among the
healthiest people in the world, have the greatest proportion of women in
the workforce, and generally go about running their society in an exemplary
manner.
The volume Mackenbach J, Bakker M, (eds.) Reducing inequalities in health:
A European Perspective. London UK: Routledge; 2002 shows how far ahead
Western Europe is in addressing the SDOH than much of the English-speaking
world.
2. http://www.health.qld.gov.au/QPHF/Documents/StrategicDirections.PDF
Queensland Public Health Forum Strategic Directions 2003 ? 2006
This document, Dynamic Network for Strategic Leadership and Advocacy for a
Healthier State, contains explicit outlines for addressing the social
determinants of health.
3. http://www.health.state.mn.us/divs/chs/mhip/
The Minnesota Public Health Department's Minnesota Health Improvement
Partnership
The State of Minnesota has one of the most advanced programs in place for
addressing the social determinants of health. The report A Call To Action:
Advancing Health for All Through Social and Economic Change
http://www.health.state.mn.us/divs/chs/mhip/action.pdf is absolutely
revolutionary for the USA.
4.
http://chd.region.waterloo.on.ca/web/health.nsf/DocID/7BBFA173A71E358C85256B1B006C6E1E?OpenDocument&Section=LIV
Waterloo (Ontario, Canada) Public Health Determinants, Planning and
Evaluation Unit
This is one of a few units in Canada applying a SDOH framework. Their
report "Our Journey" shows how and why this has come about.
http://www.region.waterloo.on.ca/web/health.nsf/0/B8980155CB5DC83C85256B140059160D/$file/Community%20Health%20Dept%20Report%20HDP&ED.pdf?openelement
5. http://www.santepub-mtl.qc.ca/english/index.html
Montreal Region (Province of Quebec, Canada) Public Health Unit
The Unit has systematically raised issues of social determinants of health
and contributed means of addressing these issues. Look specifically at the
Medical Officer of Health's reports on social inequalities in health and
urban health. The Province of Quebec is way ahead of much of Canada in
developing progressive health and social policy.
C. SUPPORT RESOURCES -- Just to get you started?
1. http://www.who.dk/document/e81384.pdf
Social Determinants of Health: Solid Facts 2nd edition
This important resource is published by WHO-EURO. My attempts to get any
coverage of its content in Canada have been difficult to say the least!
Ditto for attempts to publicize the first edition over the past three
years.
2. http://www.hc-sc.gc.ca/hppb/phdd/pdf/discussion_paper.pdf
Health Canada's Population Health Template
Health Canada staff continue to put out thoughtful, reflective materials
that document what could be accomplished through a population health
approach emphasizing determinants of health
http://www.hc-sc.gc.ca/hppb/phdd/determinants/. A summary of the document
is also available:
http://www.hc-sc.gc.ca/hppb/phdd/pdf/overview_handout_black.pdf
3. http://www.naccho.org/index.cfm
National Association of County and City Health Officials in the US acts as
a progressive force for public health.
See the NACHHO Exchange, especially the Winter 2003 issue: Creating Health
Equity
Through Social Justice at http://www.naccho.org/prod137.cfm
4. http://www.socialjustice.org/subsites/conference/index.html
Social Determinants of Health Across the Life Span: A National Conference.
This major Canadian conference considered ten key social determinants of
health, their current status and impact upon health, and suggested policy
options to strengthen them.
The website contains presentations by speakers and summaries of 80 poster
presentations on the social determinants of health. Its content forms the
basis of the forthcoming volume (July, 2004), Social Determinants of
Health, Canadian Perspectives (D. Raphael, ed.), Toronto: Canadian Scholars
Press. The Toronto Charter for a Healthy Canada grew out of the conference
and has been endorsed by Toronto and Ottawa City Councils.
http://www.socialjustice.org/subsites/conference/charter.htm
D. SOME INTODUCTORY LARGER READINGS
1. Social Determinants of Health, Selected Readings, Queensland,
Australia, http://www.health.qld.gov.au/phs/Documents/sphun/20361.pdf
2. Hofrichter, R. (ed.)(2003). Health and Social Justice: Politics,
Ideology, and Inequity in the Distribution of Disease. San Francisco:
Jossey Bass.
This volume offers a comprehensive collection of articles written by expert
contributors representing the fields of sociology, epidemiology, public
health, ecology, politics, organizing, and advocacy. Each article explores
a particular aspect of health inequalities and demonstrates how these are
rooted in injustices associated with racism, sex discrimination, and social
class.
3. Davey Smith, G. (ed.) (2003). Health Inequalities: Life-course
Approaches. Bristol UK: Policy Press.
The life-course perspective on adult health and health inequalities is an
important development in epidemiology and public health. This volume
presents innovative, empirical research that shows how social disadvantage
throughout the life-course leads to inequalities in life expectancy, death
rates and health status in adulthood.
4. Raphael, D. (2002). Social Justice is Good for Our Hearts: Why Societal
Factors -- Not Lifestyles Are Major Causes of Heart Disease in Canada and
Elsewhere. Toronto: Centre for Social Justice. On line at
http://www.socialjustice.org.
This work details how income inequality and the social exclusion that is
both cause and result of it, are directly related to illness and death from
heart disease in Canada and other developed nations. It shows how the
Canadian tradition of maintaining equity and social and health services is
weakening, thereby creating direct threats to the health of Canadians.
5. Marmot M, Wilkinson R. (eds.) (2000). Social Determinants of Health.
Oxford, UK: Oxford University Press.
This volume grew out of the Solid Facts initiative and has excellent
chapters on biological and psychosocial mechanisms, income, early childhood
and life-course influences, and social exclusion.
E. IN MY ROLE AS LIST OWNER/ I HOPE TO DO LITTLE MODERATING
From time to time, perhaps as often as once a week, I will endeavor to
provide a Bulletin that may focus on a) a specific theme; b) contains some
new developments such as reports or volumes; and/or c) reports what has
been in the NEWS (usually a very small section!) Upcoming ones may include
a) specific determinants of health; b) varying perspectives, e.g.,
political economy, social epidemiology, etc.; c) the social determinants of
specific diseases; d) class, gender, and racial perspectives; e)
globalization; f) the media; etc.
Voluntary contributors/authors of Bulletins are welcome. Perhaps
contributions could be materials such as SDOH in Australia; SDOH in the UK;
or any other relevant collection of material. Those with ideas please
contact me [log in to unmask]
I will place these Bulletins on my website in the section SDOH Listserv
Materials/Bulletins as Word files:
http://quartz.atkinson.yorku.ca/QuickPlace/draphael/Main.nsf/
Next week, for example, I plan to put together some resources on income and
its distribution that have been useful to me. Please provide me with
suggestions for inclusion: [log in to unmask]
F. IN THE MEANTIME
1. Feel free to post material, responses to posts, news, insights, etc.
If responding to something, remove the previous text before sending.
2. Respond to material, comments, etc. and do so critically if need be.
If your posting is the object of critique, remember that the criticizer
"Loves the sinner, but hates the sin."
3. Remember that when you hit the "REPLY" key, your response will go to
the entire list. If you do this by accident ? DON'T WORRY ? I am
intercepting all postings for the next while. If you wish to communicate
with me or a specific person or persons, address the message to them.
4. Archives of SDOH postings are available at
http://listserv.yorku.ca/archives/sdoh.html. The January 2004 archives
have some junk from the first week of testing. Currently, these archives
are open to the public. These could be made available only to listserv
users, if opinion is such.
5. Visit my website to obtain and use my recent presentations/papers on
SDOH: http://quartz.atkinson.yorku.ca/QuickPlace/draphael/Main.nsf/
6. The website for my social determinants of health course is
http://quartz.atkinson.yorku.ca/2003f-akhlst3010a. Feel free to download
and use presentations that are contained in the Lectures section. The
course outline is at
http://bloodstone.atkinson.yorku.ca/domino/html/outlines/crsoutlines.nsf/coursesbydocunid/10BB5D79571BAD7185256D2D004E411B?OpenDocument
7. Remember, accidents on the listserv will happen. Stay calm!
8. Pass the word on about the listserv to others! To subscribe, send
the message: subscribe SDOH yourname in the message (not subject) section
to [log in to unmask]
And finally, recall what John Belushi and Dan Ackoyd said in the "Blues
Brothers": "We are on a mission from God." :-)
Dennis Raphael
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