http://www.rhpeo.org/reviews/2004/16/

REDET: THE BEST RESOURCE OF HEALTH PROMOTION FOUND IN 2003
by Helena E. Restrepo, Consultant in Health Promotion, Columbia

Restrepo, Helena E., Redet: the best resource of health promotion found in
2003, Reviews of Health Promotion and Education Online, 2004.
URL:http://www.rhpeo.org/reviews/2004/16/index.htm.

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The best resource for my activities as consultant in Health Promotion (HP)
in 2003 was the discovery of the Network on Social Determinants, REDET,
coordinated by the University of Montreal in Canada. REDET is a
multidisciplinary discussion group that is launching an initiative to
promote debates about the study of social determinants of health, a most
relevant subject in HP.

Reading a document of REDET translated by Mauricio Gomez-Zamudio to
Spanish, opened to me a new perspective to promote the study of the
determinants of health in Latin America and for incorporating in my work
the different views that REDET is discussing. The reading was complemented
by a video, also prepared by professor Gomez-Zamudio, that presents an “in
vivo” debate among the group of Canadian experts from different disciplines
who anchor the REDET. I found fascinating this opportunity to listen to
each expert’s vision.

The REDET opens a new way to revisit and advance research on the social
determinants of health. Their effort for extending the study to several
countries in the Americas is crucial. In HP we always talk and emphasize
the importance of the social health determinants but often, we do not go
deep enough in their dimensions and their interrelationships. The materials
of REDET precisely put the finger on these aspects. The participants in
REDET call the attention to the importance of the weight of each
determinant in specific social, economic, cultural and political contexts,
which is very important.

The REDET group, in its basic documents, contends that four major
conclusions can be drawn from the results of the last two decades of
research .The first one, is a consensus about the influence of the
physical, social, economic and cultural, environments on the health of
populations. This is accepted by academics throughout the world as well as
the fact that the environment affects differently the life of persons,
families, and communities depending on a variety of circumstances. The
second is the recognition of the existence of environmental and biological
chains of factors that, again, act differentially according to the
vulnerability of persons and groups. The third, based on economic research,
points out that the socioeconomic categories are not intrinsically
homogenous and that there is a big variability within each. The fourth is
the fact that, all over the world, the States (governments) have been
extremely constrained in their social investments during the last ten years
and this fact has exacerbated the inequalities and inequities all over the
world.

The REDET documents also present five models to analyze the social
determinants in the context of the New Public Health, according to the
types of variables considered. The first model is focused on social,
collective and communitarian variables. In this model collective life is
emphasized and the social relationships in each geographical location are
singled out as important determinants of behaviors and life styles. This
model is very much related to HP practice because of its focus on
collective life.  In discussing this model, REDET, calls to attention the
subject of structural violence as a cause of different types of problems in
societies, which for me, is a priority for public health today.

The second model emphasizes the cultural dimension of behavior. The
examples that the group of experts gives expose the intimate relationships
between culture and disease and gives major importance to the study of
culture as a basic element to understand the determinants of health. The
third model considers the economic variables as main causes of the
differences in the levels of health of populations and countries. Inside
this model there are two main tendencies: the first emphasizes the gradient
of social status categories whereas the second focuses more the
inequalities due to poverty.

The fourth model is more controversial it has a political perspective and
its proponents have a very critical position about analyzing the social
determinants of health without a political ideology. The fifth and final
model is called “ Ethical Perspective of Critical Public Health” and is
focused mainly on a moral positioning of the public health workers. The
authors describe this model as a post-modern tendency that should induce
more debates among public health thinkers.

The initiative for the study of social determinants of health triggered by
University of Montreal has already involved universities in Brazil, Costa
Rica, Nicaragua and Peru. and in August 2004, a workshop will be held in
Nicaragua.  I am sure that this extension of REDET as a Panamerican Network
is going to be of great value to Latin America.

More information at: www.usi.umontreal.ca/redet

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REFERENCES

REDET Módulo 1A: Fundamentos conceptuales; teorías de determinación social
de la salud. Red de Formación.

REDET Módulo 1B: Movimientos sociales en salud. Universidad de Montreal,
Canadá.

Video: Red sobre los determinantes sociales de la salud REDET. Mesa
Redonda: Las cuatro caras de la salud y la enfermedad.










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Last modified: June 22, 2004

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