Also, even at the level of distributions of determinants of health, we too
often are not working from theories of either (a) how they affect health,
including through interaction with other determinants, and (b) why their
distribution developed as it has and how it could be changed. A simple
example: greatly improving the distribution of education without changing
the distribution of jobs, working conditions and wages, could be expected
to greatly flatten the association between education and health, but not
have much effect on socio-economic health inequities (especially to the
extent these are heavily influenced by the distribution of work-related
resources and conditions.) It might improve health literacy but not the
options people have to make "healthy choices" which require time, money and
access to get and prepare healthy food, exercise, spend time with children,
live in safe neighborhoods, get quality child care, have [time and energy
for] good social relations, de-stress, etc.
To Dennis'/Mills important point about psychologism, add ahistoricism: the
failure to understand the historical social structural forces shaping the
current distribution of determinants, such as recent decades of declining
wages, benefits, and secure living income jobs, along with increasing
income inequality, household debt and economic insecurity. If we don't
understand what the social structural forces shaping determinants are and
how they've gotten us where we are, how can we effectively hope to
intervene?
One conclusion: Any model of determinants of population health has to
specify, under macro-level forces, corporations. Their key role in shaping
living conditions and resources includes the distribution of jobs, wages,
unions, and working condiitions, and their effect on public policies
(especially regulatory, unionization, tax, military and social
service/benefit policies) and ideology (through the media). Could this
recession and current politics and public policy discussion possibly make
this clearer?
____________________________________________
Randy Reiter, PhD, MPH, Population and Community Health Epidemiologist
Maternal, Child and Adolescent Health
Community Health Epidemiology
Community Programs
San Francisco Dept. of Public Health
30 Van Ness, Suite 260
San Francisco, CA 94102
[log in to unmask]
phone: 415 575-5767 fax: 415 575-5799
Far better an approximate answer to the right question, which is often
vague, than an exact answer to the wrong questions, which can always be
made precise.
--JW Tukey, The future of data analysis, Ann math stat, 1962; 33:13-14
Social determinants of health are life-enhancing resources, such as food
supply, housing, economic and social relationships, transportation,
education, and health care, whose distribution across populations
effectively determines length and quality of life
- CDC
Medicine is a social science, and politics is but medicine on a large
scale.
-Rudolf Virchow, Die medizinische Reform, 2. In Henry Ernest Sigerist,
Medicine and Human Welfare, 1941: 93
I don't believe in charity. I believe in solidarity. Charity is so
vertical. It goes from the top to the bottom. Solidarity is
horizontal. It respects the other person. I have a lot to learn from other
people.
- Eduardo Galeano
Dennis Raphael
<[log in to unmask]
A> To
Sent by: Social [log in to unmask]
Determinants of cc
Health
<[log in to unmask]> Subject
Re: [SDOH] Heath Literacy as a Key
Determiant of Health
02/04/2011 04:09
AM
Please respond to
Social
Determinants of
Health
<[log in to unmask]>
A concrete variable that is closer to the phenomenon will always correlate
better than a structural variable such as social class. One example is
that "angry" people will be more likely to hit their children than whether
they are employed or not. Another is that gross obesity is correlated with
adverse health outcomes. However such empirical associations provide no
explanatory value as they does not provide a theory of the phenomenon. You
can have the most literate person in the world but have them lose their job
and become homeless and I doubt their knowledge will do them much good.
This can be another manner by which the powers that be can avoid structural
issues and place the explanation for an adverse outcomes(s) as an
individual level characteristic rather than a structural one. For example,
I doubt whether the poverty-children's asthma relationship can be explained
as a lack of health literacy on the part of their parents, etc.
See C. Wright Mills on psychologism as explanation
Mills argues that the problem of such social research is that there may be
a tendency towards “psychologism”, which explains human behavior on the
individual level without reference to the social context. This, he argues,
may lead to the separation of research from theory. He then writes of the
construction of milieu in relation to social research and how both theory
and research are related (Mills, 1959, 65-68).
see also attached.
dr
.
Get a free copy of Social Determinants of Health: The Canadian Facts at
http://thecanadianfacts.org
Dennis Raphael, PhD
Professor of Health Policy and Management
York University
4700 Keele Street
Room 418, HNES Building
Toronto, Ontario M3J 1P3
416-736-2100, ext. 22134
email: [log in to unmask]
http://www.atkinson.yorku.ca/draphael
Of interest:
* NEW * About Canada: Health and Illness
http://tinyurl.com/2c2tm6l
Health Promotion and Quality of Life in Canada: Essential Readings
http://tinyurl.com/ycb4rm5
Social Determinants of Health: Canadian Perspectives, 2nd edition,
Forewords by Carolyn Bennett and Roy Romanow
http://tinyurl.com/5l6yh9
Poverty and Policy in Canada: Implications for Health and Quality of Life
Foreword by Jack Layton
http://tinyurl.com/2hg2df
Staying Alive: Critical Perspectives on Health, Illness, and Health Care,
2nd edition
Foreword by Gary Teeple
http://tinyurl.com/yehawne
See a lecture! The Politics of Population Health
http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d
Also, presentation on Politics and Health at the Centre for Health
Disparities in Cleveland Ohio
http://www.case.edu/med/ccrhd/education
[attachment "1. C. W. Mills .pdf" deleted by Randy Reiter/DPH/SFGOV]
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