Health Equity: 09/04/08

Thursday, September 4, 2008

[EQ] Epidemiology and the Macrosocial Determinants of Health

Epidemiology and the Macrosocial Determinants of Health

Sara Putnam1 and Sandro Galea1,2,3

1Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA

2Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA

3Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

Journal of Public Health Policy (2008) 29, 275–289. doi:10.1057/jphp.2008.15

Abstract: http://www.palgrave-journals.com/jphp/journal/v29/n3/abs/jphp200815a.html

“….In the past two decades, public health researchers have taken renewed interest in investigating the role of social factors in health. This holds substantial promise in terms of identifying manipulable social factors that are amenable to policy intervention. Most existing empirical and conceptual epidemiologic work, however, has focused on the more proximal social determinants, such as interpersonal relations.

These factors, although perhaps easier to study epidemiologically, are much less relevant to policy makers than more "macrosocial" factors such as taxation policies. Limited epidemiologic attention to macrosocial determinants of health is ironic given that macrosocial factors such as the rapid industrialization and urbanization in the 19th century contributed to the organization of public health practice and, tangentially, to academic public health research.

We suggest here that greater investment in the study of macrosocial determinants has the potential to make a significant and unique contribution to the greater public health agenda and should be a prominent aspect of social epidemiologic inquiry in the coming decades…..”

Commentary: Population-level Risk Factors, Population Health, and Health Policy

This commentary urges attention to population-level factors that affect health, adding a practical element to the article on macrosocial determinants of health.
Elena N Naumova and Steven A Cohen
J Public Health Pol 29: 290-298; doi:10.1057/jphp.2008.21 - Abstract

Commentary: Macrosocial Determinants, Epidemiology, and Health Policy: should politics and economics be banned from social determinants of health research?

After considering the reasons that epidemiologists have restricted their studies, these authors find reason for optimism in the new interest in macrosocial factors.
Carles Muntaner and Haejoo Chung
J Public Health Pol 29: 299-306; doi:10.1057/jphp.2008.23 - Abstract

Population Health and the Hardcore Smoker: Geoffrey Rose Revisited

Challenging the "hardening hypothesis," these Canadian authors note that Geoffrey Rose's model predicts that the effect of policy interventions, and changes in social norms, will shift the population-level risk distribution for continuing to smoke, making it more likely that all smokers will quit.
Michael O Chaiton, Joanna E Cohen and John Frank
J Public Health Pol 29: 307-318; doi:10.1057/jphp.2008.14 - Abstract

Clustering Countries to Evaluate Health Outcomes Globally

Country clusters can and should be used to study societal conditions that contribute to changes in health outcomes over time.
Sue Thomas Hegyvary, Devon M Berry and Alejandro Murua

J Public Health Pol 29: 319-339; doi:10.1057/jphp.2008.13 - Abstract

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] Tackling Health Inequalities - A n All-Ireland Approach to Social Determinants

From: David McDaid - LSE Health and Social Care

Tackling Health Inequalities An All-Ireland Approach to Social Determinants

Compiled by Clare Farrell, Helen McAvoy, Jane Wilde and Combat Poverty Agency

Preface by Sir Michael Marmot

Combat Poverty Agency in association with the Institute of Public Health in Ireland, 2008

ISBN: 978-1-905485-63-5

Available online PDF [64p.] at: http://www.publichealth.ie/files/file/Tackling%20health%20inequalities.pdf

“… the report highlighted the extent to which health outcomes are influenced by social factors, such as poor housing, nutrition and education, and explains the higher level of ill-health found among poor and socially excluded groups in Ireland, North and South. …”

“…..As with natural phenomena that become disasters so it is with man-made disasters that cause as much havoc as natural phenomena can. This report highlights that the Troubles in Northern Ireland disproportionately affected the poor. Armed conflict and extreme natural phenomena are grisly demonstrations of the link between social processes and health inequalities. They illustrate a more general rule. The effects on health of social processes, in general, follow the social gradient: the lower the socioeconomic position the more health is affected by the social determinants of health.

This is one of the messages that comes through clearly from this report from the Institute of Public Health and Combat Poverty. The report contains an excellent review of the field of social determinants of health and has a welcome call for action. It says that: “policy commitments need to be championed, prioritised and resourced”. As the report makes clear, formulating recommendations and promoting their uptake are necessary steps. The accounting will come from having good measurement systems to assess their impact on the distribution of health within Ireland….” From: Michael Marmot, Chair of the Commission on Social Determinants of Health

Contents

Foreword

Preface

Introduction

Part One: Concepts, Definitions and Theories

What are Social Determinants of Health?

What are Health Inequalities?

Multiple causes

Measuring health inequalities

A life course perspective

Global issues

Working for Health Equity

Approaches and principles

Part Two: Health Inequalities in Ireland and Northern Ireland

Tackling Health Inequalities

Part Three: Key Social Determinants of Health

1. Poverty and Inequality

2. Social Exclusion and Discrimination

Gender

Ethnicity

Travellers

Asylum Seekers, refugees and low income migrant workers

Homelessness

Disability

Mental Health

Sexual Orientation

3. A Life Course Perspective

Pregnancy

Childhood

Older Age

4. Public Policies and Services

Health services

Education

Housing and accommodation

Transport

5. The Built Environment

6. Work and Employment

7. Community and Social Participation

8. Health Behaviours

Alcohol

Food

Smoking

9. Stress

References

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[EQ] WHO report calls for global action to ensure health equity within and between countries

Editorial

Tackling health inequities

WHO report calls for global action to ensure health equity within and between countries

George Davey Smith and Nancy Krieger
BMJ 2008;337:a1526, doi: 10.1136/bmj.a1526 - Published 3 September 2008

Available online

“…..Finally, an official report on health inequity has been published that has the honesty and courage to say that "social injustice is killing people on a grand scale."1 The report of the World Health Organization’s Commission on Social Determinants of Health synthesises evidence from a large and disparate range of sources, while recognising that what constitutes evidence is itself contested and not value free.2 It presents a wealth of data to show the unquestionable link between economic, social, and bodily wellbeing—within and across countries. In the case of life expectancy, these embodied facts of social inequity3 can span the equivalent of a lifetime: women born in Botswana can anticipate living an average of 43 years, half that of the 86 years for women in Japan; between the poorest and most affluent parts of Glasgow life expectancy in men ranges from 54 to 82 years.

Many official reports have documented social inequalities in health over the past 170 years, from Chadwick4 to Sachs.5 Yet, in contrast to these reports, which subtly (and not so subtly) emphasised the detrimental effects of poor health induced by poverty on economic performance,6 the commission firmly draws the arrow of causality from impoverished environments to ill health, something that is clear to most of the world’s population (if not to some economists).

The ability of this report to make these conclusions rests on its unprecedented broad scope—unlike many other reports that have focused on one country or on groups of countries at similar economic levels, the commission has produced a global picture of economic and social deprivation that makes it impossible not to recognise the importance of economic redistribution, health care, and the direct material consequences of poverty and social inequality across the life course on health. …”

The Lancet 2008; 372:689 - DOI:10.1016/S0140-6736(08)61282-9

Editorial

Addressing the inequities in health: a new and vital mandate

The Lancet, Volume 372, Number 9640, 30 August 2008

http://www.thelancet.com/journals/lancet/article/PIIS0140673608612829/fulltext

“…..The Commission talks unashamedly about social justice, a phrase that is used more by politicians than health professionals. But the inequities and inequalities in health that exist today must surely prick the concern and conscience of every physician. The problem for most doctors is likely to be the twin feelings of hopelessness and impotence at the sheer scale of the difficulty they face. Those feelings often translate into paralysis. The Commission's most refreshing conclusion is that hopelessness, impotence, and paralysis can be overcome by optimism, vigour, and muscular policy responses. Why? Because the evidence already shows that much can be achieved to reduce inequity and inequality….”

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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.