Whither social determinants of health?

Abstract

This critical commentary extends the debate on social determinants of health and disease. Its main argument is that while further studies are unnecessary to demonstrate the fundamentally social distribution of health outcomes, extant analyses rarely engage with the fact that poverty and other forms of oppression are political choices made by societies, which are both contemporaneously contingent and historically situated. This view must guide research and debate in the area so that studies intending to bring injustice to light do not end up naturalizing it. Research based on this fundamental understanding may help to overcome the narrow scope of multicausal black box approaches, which do not analyze the interrelations among determinants and make only a limited contribution to the construction of healthy societies.

Advancing racial equity in oral health (research): more of the same is not enough

“…Notably, some four (22%) studies went beyond this reasoning, and investigated the links between racial oppression and oral health by making reference to life course or psychosocial theoretical frameworks. It is against this backdrop of myriad risk factors for poor oral healthwhich very much resembles black box epidemiology (36,37) that most publications provided readers with vague recommendations to address racial/ethnic inequities in the field, including 'tackling social determinants of oral health' (22), 'addressing psychosocial stressors that affect oral health' (27), and 'promoting policy changes addressing socioeconomic inequities' (18). Notably, in addition to mostly relying on SES to address racial/ethnic inequities in oral health, rarely did studies propose clear strategies to attack or dismantle racism as a structural feature of our societies.…”

“…There can be no oral health equity where power and control over institutions/resources are concentrated in the hands of a few social actors and their corresponding social groups. Scholars should thus not only work to strengthen theory and evidence that links social justice with oral health in their studies, but necessarily make practical recommendations that effectively help us build fairer societies (36). Implicitly or explicitly advocating that oppression is bad because it harms oral health is clearly not a practical recommendation to be made, nor one that is conducive to a more just world.…”

“…Such research initiatives are unnecessary and potentially misleading, as oppression is wrong by definition, not because it underlies poor oral health and oral health inequities. Investigations that do not go beyond this problematic conclusion may operate as social buffers and also help maintain the status quo (36) rather than assisting in the formulation of clear strategies to address the most important and fundamental problem: social injustice characterized by imbalance in power and control over institutions/resources among social groups (6,14).…”

Physical inactivity as a risk factor to mortality by ischemic heart disease during economic and political crisis in Brazil

“…Economic and political changes are part of society and bring consequences for population health indicators (Nedel & Bastos, 2020). Policies of economic and social incentives, as was the case in Brazil's health system in 1988-SUS-which is characterized as universal, free and of quality, directly reflect in the health care of the entire population, regardless of economic and social level of the population (McKee et al, 2012;Paim, 2018; This study aims to investigate the mortality burden due to IHD attributable to low levels of physical activity from 2007 (before the economic and political crises) to 2017 (during and after of the crises) in the Brazilian population aged ≥ 25 years from different socially and economically distinct geographic regions.…”

“…Economic and political changes are part of society and bring consequences for population health indicators ( Nedel & Bastos, 2020 ). Policies of economic and social incentives, as was the case in Brazil’s health system in 1988—SUS—which is characterized as universal, free and of quality, directly reflect in the health care of the entire population, regardless of economic and social level of the population ( McKee et al, 2012 ; Paim, 2018 ; Castro et al, 2019 ).…”