Onions and Bubbles: Models of the Social Determinants of Health
FROM THE EDITOR IN CHIEF: Lynne S. Wilcox
Prev Chronic Dis Volume 4: No. 4, October 2007
US Centers for Disease Control and Prevention -National Center for Chronic Disease Prevention and Health Promotion
“……..The discussion of society and health is complex and sometimes confusing. What is social medicine? What is community medicine? What is the socioecologic model? All these terms have been used to describe the relationship between health and other social conditions. Even public health professionals may find the differences blurred.
The previous issue of Preventing Chronic Disease discussed community health and community-based participatory research (1). Multiple factors affect a community’s function and, in turn, the health of its citizens, and our October issue examines the broader context in which communities operate…”
Social Determinants of Health: What, How, Why, and Now
Marilyn Metzler, Koger Center, CDC, Atlanta, GA
Prev Chronic Dis Volume 4: No. 4, October 2007
US Centers for Disease Control and Prevention -National Center for Chronic Disease Prevention and Health Promotion
Available online at: http://www.cdc.gov/pcd/issues/2007/oct/07_0136.htm
“…..Efforts to improve the conditions for health will present many challenges, not least among them the possibility for unintended effects. In her editorial in this issue, Wilcox uses a playful image of interacting bubbles, connected to each other by dynamic processes, to explore the topic of models that seek to describe the multiple factors affecting health (14).
Just as a change in one bubble creates changes in the others, even small changes in complex systems can affect the entire system. Improving disadvantaged neighborhoods by adding walking trails and full-service grocery stores can set into motion gentrification processes that displace low-income residents (15). Improving access to education can create despondency in people unable to find jobs where they can use their new skills (16). Systems modeling is one way to explore these interconnected relationships by thinking critically about plausible futures through the use of what-if scenarios (17)…..”
Do We Have Real Poverty in the United States of America?
Paula Braveman, Professor of Family and Community Medicine and Director, Center on Social Disparities in Health, University of California, San Francisco
Prev Chronic Dis Volume 4: No. 4, October 2007
US Centers for Disease Control and Prevention -National Center for Chronic Disease Prevention and Health Promotion
Available online at:http://www.cdc.gov/pcd/issues/2007/oct/07_0124.htm
“…..Consider the images of starving children in Africa, Asia, or Latin America accompanying appeals for humanitarian aid. It is not difficult to understand why people deprived of the most basic material necessities for subsistence — adequate food, clean water, shelter from extreme heat or cold — would suffer high rates of preventable disease, disability, and premature death. Poverty in developing countries is often defined as living on less than $2.00 per person per day (1). By those terms, very few people in the United States would be poor.
But poverty criteria for poor countries are not applicable in affluent countries with far higher living costs. The official U.S. poverty guideline in 2005 was an annual income of $19,350 for a family of four (2), which would represent wealth in many poor countries (3). Why, then, are Preventing Chronic Disease and other U.S. journals participating in this multi-journal issue, to be released October 22, 2007, on poverty and human development? Is it simply a magnanimous gesture to support fighting poverty and its adverse health consequences in poor countries, or is poverty an issue we must address at home?....”
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