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The social determinants of health: how can th. . .

The social determinants of health: how can the community sector help?

By VCOSS.
Published on the VCOSS Voice on 18 December 2013.
http://vcoss.org.au/blog/the-social-determinants-of-health-how-can-the-community-sector-help/

A recent public health study revealed that poverty has a greater impact on child development than the use of cocaine during pregnancy. Dr Gemma Carey from the Centre for Excellence in Intervention & Prevention Science and Liz Callaghan from Catholic Health Australia note that “this type of research packs a serious punch when it comes to advocating for social policy change”.

In their post below, they outline evidence around the social determinants of health and call for stronger links between social policy and public health, saying that linking health to welfare and disadvantage “opens new doors for policy change”. They urge the community sector in particular to engage more closely, saying it is “perfectly positioned to strengthen explanatory models concerning the social determinants of health”.

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They write:

This year has seen the establishment of the Australian Social Determinants of Health Alliance (now with over 60 organisational members) and the release of the final report from the Senate Inquiry into the Social Determinants of Health. The social determinants of health also form the basis of the Council of Social Service (COSS) network’s action on health equity.

But what are the social determinants of health?

The ‘social determinants of health’ is simply another name for the type of social problems the community sector works to address every day, such as housing, income insecurity, poor access to education and disadvantage.

Public health research has shown that these social issues are the primary cause of health problems like cardiovascular disease, diabetes and obesity. Socioeconomic position can predict who develops and eventually succumbs to heart disease, diabetes, respiratory disease and particular cancers.

As well as the obvious material deprivation, socioeconomic status also has a profound effect on the psychological and physiological resources we need in order to make the most of the opportunities we have. For example, women from disadvantaged backgrounds are more likely to have lower birth weight babies. Low birth weight is strongly associated with poor long-term health outcomes.

Health is now understood to follow a social gradient. We can see this in the graph below of childhood development by socioeconomic status. Although conducted in 1970, it shows that children who have low cognitive scores at 22 months, but grow up in families of high socioeconomic position, improve as they age. Children who grow up in families with a low socioeconomic position who have high scores decline as they age. If children who grow up in these families have low scores to start with, they never catch up. This research highlights how inequities can become entrenched and limit people’s life chances.

A more recent study in 2005 showed that in the United States the mortality rate was 206.3 per 100,000 for adults aged 25 to 64 years with little education beyond high school, but was twice as great (477.6 per 100,000) for those with only a high school education and three times as great (650.4 per 100,000) for those less educated. The study showed that social conditions (such as education, income and race) were both dependent on one another, and had independent effects on health.

The realisation that social issues create poor health brings a wider range of sectors and professionals to the table on issues of social disadvantage. For example, as well as the public health community there is now growing recognition amongst health service providers of the need to address social disadvantage. With this comes knowledge, expertise and resources.

For social policy advocates, linking health to welfare and disadvantage opens new doors for policy change. Health care providers have significant resources and serious political clout, while public health has an impressive history of public advocacy and policy change based on ground-breaking research. As Professor Robert Douglas reported on the Conversation, a recent public health study revealed that poverty has a greater impact on child development than the use of cocaine during pregnancy. This type of research packs a serious punch when it comes to advocating for social policy change

While the Senate Committee acknowledged the effect of social disadvantage on health, unfortunately explicit action on the social determinants of health is yet to be taken.

Bridging sectors and building alliances

While social determinants of health has been a central concern of the World Health Organisation for well over a decade, and been the subject of extensive reviews in the UK and Europe, in Australia the movement is in its infancy.

While researchers such as those at the Southgate Institute have been studying the social determinants of health in Australia for sometime, it has taken until 2013 for federal politicians to begin to think about how Australia should respond to the WHO’s research and recommendations on tackling the social determinants of health.

Similarly, the Australian National Health and Medical Research Council only recently held roundtable discussions to discuss priority research areas concerning the social determinants of health. This is yet to flow on to grant committees, with the most recent NHMRC funding round awarding only 65 out of 652 to public health, and even less to social determinants of health research.

This means that we are yet to break down the barriers between different sectors that have a stake in addressing the social determinants of health. For instance, public health is still taken to mean health care and more ‘life style’ based issues such as smoking and obesity. This means that shared territory is yet to be recognised.

However, with the Senate Committee on the social determinants of health, and the establishment of the Social Determinants of Health Alliance, the momentum is building.

To keep this going, it needs the energy and insight of other sectors – including the community sector.

By engaging and partnering with public health and health care providers and advocates, the community sector can strengthen efforts to understand and improve the social determinants of health.

Much public health research around the social determinants of health is focused on population level data, using abstract statistical models. This data is very important for understanding critical trends and changes in the population.

However, how this data relates to the real lives and contexts of individuals is largely unknown. This means that the models that underpin the social determinants of health movement are, as David Coburn argues, “unable to address the ways in which people individually and collectively act to improve their health”.

Here, the community sector in particular has a lot to offer. The sector is perfectly positioned to strengthen explanatory models concerning the social determinants of health. It works closely with individuals, building an understanding of their lives and the barriers and enablers they experience to improving their social circumstances (and in turn, their health).

This type of insight is pivotal to unpacking the relationships between social issues and health outcomes, and importantly finding the pathways for change. In fact, without it, social determinants of health research and advocacy can’t move forward.

With the growing recognition of the importance of addressing the social determinants of health, the community sector and public health – as well as health providers – are increasingly concerned with the same issues and confronted by the same problems. That is, how to address disadvantage.

The social determinants of health has the potential to act as a bridge between these different sectors – improving the way they work together and creating more fire power when it comes to arguing for policy change.

What can you do to help?

The community sector must make sure its voice is heard in this new debate.

This means reading the research, engaging with public health researchers and joining the Social Determinants of Health Alliance.

By joining the Alliance and engaging with public health researchers, the community sector can help to develop knowledge of the social determinants of health and ways to address them, and begin to implement proven strategies.

In building the social determinants of health movement, the sector can not only help shift the focus of funding bodies like the National Health and Medical Research Council so there is greater investment in research that tackles the problems of social disadvantage and inequity, but can be involved in, and indeed lead, the synthesis of evidence into practical strategies for change.

The new Social Determinants of Health Alliance, provides the ideal platform to begin engaging across sectors over social determinants of health issues – we urge you and your organisations to join up today.