On Tue, 21 Oct 2003 13:27:23 -0400, Brian Hyndman <[log in to unmask]> wrote:

>Not sure about the origins of the "social determinants of health". I first
came across the phrase "determinants of health" in the 'Nurturing Health'
report published by the now-defunct (Ontario) Premier's Council on Health,
Well-being and Social Justice in 1991.
>
>
>Dennis Raphael wrote:
>
>> Can anyone identify the origins of the term "social determinants of
>> health"?
>>
>> Was it 1998 with the WHO-EURO document?
>>
>> Can anyone recall seeing it, using it, earlier?
>>
>> Thanks,
>>
>> dennis
>>
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>--

Earlier this year, in response to a similar request by an Ontario Healthy
Communities Animator, I went looking for references on 'determinants of
health'. I started with the Premier's Council on Health Strategy (1987-91)
and their document called "Nurturing Health: A Framework on the Determinants
of Health" published in early 1991.  Like all the documents that I checked,
there is reference to the "New Perspective on the Health of Canadians", the
1974 Lalonde report which identified 'health fields', but did not discuss
the differences in social environment between various subgroups in society
(nor refere to the words 'd. of h.'). The 'Nurturing Health' paper refers to
the Canadian Institute for Advanced Health (CIAR) research papers of 1989-90
"Producing Health, Consuming Health Care" by Robert Evans and Greg Stoddart,
and one by T.R. Marmor on "Healthy Public Policy: What Does That Mean, Who
is Responsible...".

In the Evans & Stoddart paper, their references to 'determinants of health'
are linked back to an understanding of the definition of health, and the
health fields described in the New Perspective of Canadians.  To quote:

"Whatever the level of definition of health being employed, however, it is
important to distinguish this from the question of the determinants of (that
definition of) health" [in which they attribute that statement to T.R.
Marmor of CIAR in 1989].

"Here too there exists a broad range of candidates, from particular targeted
health care services, through genetic endowments of individuals,
enviornmental sanitation, adequacy and quality of nutrition and shelter,
stress and the supportiveness of the social environment, to self-esteem and
sense of personal adequacy or control."...

"The current resurgence of interest in the determinants of health, as well
as in its broader conceptualization, represents a return to a very old
historical tradition, as old as medicine itself"

"Our purpose is not to try to present a comprehensive, or even a sketchy,
survey of the current evidence on the determinants of health. Even a
taxonomy for that evidence, a suggested classication and enumeration of the
main heads, would now be a major research task. Rather, we are trying to
construct an analytic framework within which such evidence can be fitted,
and which will highlight the ways in which different types of factors and
forces can interact to bear on different conceptualizations of health. Our
precedent is the federal government's White Paper, A New Perspective on the
Health of Canadians which likewise presented very little of the actual
evidence on the determinants of health, but offered a very powerful and
compelling framework for assembling it."

I checked a few other papers and references, and most said something similar
- referring to the Lalonde report or to the Charter of Health Promotion as
'precedents'. There was one reference to Richard Wilkinson, ed. "Class &
Health" (London: Tavistock, 1986); but since I can't get ahold of his book,
I can't confirm that he used the term.

I think that it slipped into common parlance about 1988.

Alison

~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *
Alison Stirling, health promotion consultant
Ontario Prevention Clearinghouse (OPC)
Suite 1900, 180 Dundas St. W. Toronto, ON M5G 1Z8
Email: [log in to unmask]
Internet: http://www.opc.on.ca
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