Hi Denis
It is hard to pin these down!

I think Wilkinson & Pickett would fit into row 3 in your table, but they
focus on one particular pathway: psychosocial stress.

The WHOCSDH 2008 report seems inconsistent to me.
On page 1, it says:
This unequal distribution of health-damaging experiences is not in any sense
a 'natural' phenomenon but is the result of a toxic combination of poor
social policies and programmes, unfair economic arrangements, and bad
politics.
More strongly, on page 31 it says: 'This unequal distribution is not in any
sense a 'natural' phenomenon but is the result of policies that prize the
interests of some over those of others - all too often of a rich and
powerful minority over the interests of a disempowered majority.'
So to me it bridges 5 to 7 in your table.
But on page 42 it identifies the structural drivers as:
. the nature and degree of social stratification in society - the magnitude
of inequity along the dimensions listed;
. biases, norms, and values within society;
. global and national economic and social policy;
. processes of governance at the global, national, and local level.
Notably, policy and governance are 3rd and 4th in the list. I think order
matters a lot.
Listing social stratification first, and biases etc. second, *does* imply a
natural phenomenon to me.
Also it seems inconsistent about what social determinants of health means.
Page 1: 'Together, the structural determinants and conditions of daily life
constitute the social determinants of health and are responsible for a major
part of health inequities between and within countries.'
But page 26: 'Daily living conditions, themselves the result of these
structural drivers, together constitute the social determinants of health.'
Read literally, this restricts SDH to daily living conditions, not the
structural drivers per se - maybe an editorial mistake?
This is reinforced by the fact that on page 42 it says:
'This framework suggests that interventions can be aimed at taking action
on:
The circumstances of daily life:
.
And the structural drivers:
.'
Again I think order matters, and I think the recommendations will be
operationalised primarily as focusing on daily living conditions, with the
structural drivers as an afterthought.

Melissa
________________________________

From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of
Dennis Raphael
Sent: Saturday, 5 September 2009 8:30 PM
To: [log in to unmask]
Subject: Re: [SDOH] left out Erik Olin Wright!
Melissa, where would you place these publications?  I wanted to identify
clear specific empirical referents in the table. 
dr 

Melissa Raven <[log in to unmask]> 
Sent by: Social Determinants of Health <[log in to unmask]> 

09/04/2009 09:59 PM 
Please respond to
Social Determinants of Health <[log in to unmask]>

To [log in to unmask] 
cc
Subject Re: [SDOH] left out Erik Olin Wright!

Hi Dennis 
Thanks, I think this is a very useful table. 
  
But I think two phrases are ambiguous: 
Limited focus upon service provision 
Limited focus upon health behaviours 
They could be interpreted as not paying much attention to service provision
and health behaviours respectively. Yes, if someone reads the table and
context properly, it will be obvious that that is not what is meant. But
many people do not read things properly, and things get quoted without
proper explanation. I suggest: 
Focus limited to service provision 
Focus limited to health behaviours 
  
Also, I think there are a few prominent SDHers/publications that are not
mentioned, and it would be good to include them to help people who are
familiar with them to orient themselves in the table/discourses. Some that
spring to mind are: 
WHO Commission on Social Determinants of Health 
Wilkinson & Marmot 2003 Social determinants of health: The solid facts [WHO]

Wilkinson & Pickett 2009 The spirit level [I haven't read the book yet, but
from what I've read about it I think they place too much emphasis on an
*internalised* sense of inequality/status rather than its outward
expressions, e.g. exploitation in employment and the housing market etc.] 
Kawachi & Kennedy 2002 The health of nations: Why inequality is harmful to
your health 
Graham & Kelly 2004 Health inequalities: Concepts, frameworks and policy 
  
But of course there are lots more, and it would not be feasible to include
them all. 
  
Cheers 
Melissa 

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