Three articles in the current issue of : J Epidemiol Community Health
1 December 2008; Vol. 62, No. 12
Iconography and Commission on the Social Determinants of Health (and health inequity)
J Epidemiol Community Health 2008;62 1018-1020
“…. The report by the World Health Organization’s (WHO) Commission on Social Determinants of Health (CSDH) (Closing the gap in a generation: health equity through action on the social determinants of health)1 was launched on 28 August this year. In this issue, timed to coincide with a conference of the same name being held in
Theory and methods
Ladders, pyramids and champagne: the iconography of health inequities
J Epidemiol Community Health 2008;62 1098-1104
“… Conceptual models are crucial for theorising, depicting and explaining population distributions of health inequities. This is because a visual conceptual model, like a map, can simultaneously organise and spur ideas and observations. Incorporating both imagery and metaphor, visual models not only illustrate key constructs and causal relationships specified by scientific theories but also provide an important tool for integrating and evaluating rapidly emerging findings and for guiding new research.
It therefore is instructive to consider and contrast different sets of images appearing in the public health, policy and popular literature pertaining to (1) social stratification, (2) determinants of population health and (3) determinants of health inequities. At issue is how different types of images illuminate, or obscure, the relevant causal processes that need to be altered to improve population health and reduce health inequities.
Of particular concern are conceptual confusions created when (a) models inaccurately depict the distribution of population and resources and (b) models of determinants of population health, rather than of determinants of health inequities, are used in discussions about social inequalities in health. Although perhaps a pragmatic argument can be made for use of less politically controversial imagery in policy-oriented documents, I would argue that the public’s health will be better served by an iconoclastic iconography, one that clearly and unequivocally delineates the social facts of skewed distributions of power and resources and depicts the societal processes that generate and maintain these distributions and their embodiment in population levels and distributions of health, disease and well-being….”
Evidence-based public health policy and practice
Global health equity: evidence for action on the social determinants of health
M Marmot and
J Epidemiol Community Health 2008;62 1095-1097
“….More than 30 years ago, the older of us published a paper with the proposal that all scientific papers should start with a statement along the lines of: "These are the opinions on which I base my facts". Why pretend? To take a topical example, if you are on the nature side of the nature/nurture debates, is it likely that your next paper will be an apologia: "I take it all back; genes don’t matter at all; it is all environment"? Unlikely. Similarly, if you are on the other side. (We know. It’s both.) Here, we are not in any way arguing for a relativist credo that would say opinions are all. Along with other readers of this journal, we spend a good part of our working lives gathering, analysing and interpreting empirical evidence. Evidence matters. But everyone has values and they do affect our positions….”
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