Social Determinants of Health
The study of the social roots of disease began in earnest during the Industrial Revolution and is exemplified in the works of writers like the French physician Louis Rene Villerme (see Social Medicine 101) and the German physician/politician/anthropologist Rudolf Virchow (see Howard Waitzkin’s article in volume 1, number 1 of Social Medicine). With the development of microbiology in the late 19th century, it seemed that “the” true cause of disease had been found and social explanations were seen as somewhat quaint. However, social explanations for disease have never truly gone out of fashion. As Christopher Hamlin has noted, despite the microbiologic revolution many diseases - even infectious ones - continue to kill people at high rates. Some infectious diseases clearly require social interventions (such as improvements in diet and water supply). Even in infectious diseases, the sole presence of a pathogen is rarely able to explain the patterns of disease prevalence and natural history. Finally, many of the health issues facing us today - such as diabetes and smoking - are not uni-causal. As a consequence, we have seen a flourishing of interest recently in the social determinants of health.
The British Medical Journal maintains a collection of articles related to the socio-economic determinants of health. Many of the most important themes in the field are debated in these articles, so they are well worth a look.
The Canadian Center for Social Justice (CSJ) has posted abstracts from their 2002 conference on “Social Determinants of Health across the Life Span”. The conference produced the Toronto Charter (PDF), a program to improve Canadians’ health through strengthening the social determinants of health.
From York University in Canada is the Social Determinants of Health list serve, run by Dennis Raphael. In 2006 Dr. Raphael published a overview of “theory and research concerning social determinants of health that is available on-line: “Social Determinants of Health: Present Status, Unanswered Questions, and Future Directions.”
MacArthur Research network on Socioeconomic Status (SES) and Health. The overall goal of the network is to identify the mechanisms by which socioeconomic status affects health status. The Social Environment Notebook contains chapters on measurement of income inequality, educational status, and overviews of environmental conditions affecting health in both work and home settings. In addition the Social Environment Notebook includes a Sociodemographic Questionnaire developed by the Network, which includes questions to assess educational, economic and occupational status.
Population Health Forum. Population health looks at the most important factors that determine the health of nations and parts of nations. Why is the USA less healthy than pretty well all the other rich countries and a few poor ones, despite spending almost half of the world’s health care bill? The Population Health Forum’s website addresses these issues.
Finally, the website of the World Health Organization’s Commission on the Social Determinants of Health has a wide variety of reports - some for general audiences and some quite detailed. It is well worth perusing these materials.
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