What We Mean by Social Determinants of Health

Abstract

This article analyzes the changes in health conditions and quality of life in the populations of developed and developing countries over the past 30 years, resulting from neoliberal policies developed by many governments and promoted by the World Bank, International Monetary Fund, World Health Organization, and other international agencies. It challenges interpretations by the analysts of "globalization", including the common assumption that states are disappearing. The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country, with establishment of an alliance between the dominant classes of developed and developing countries-a class alliance responsible for the promotion of its ideology, neoliberalism. This is the cause of the enormous health inequalities in the world today. The article concludes with a critical analysis of the WHO report on social determinants of health, applauding its analysis and many of its recommendations, but faulting it for ignoring the power relations that shape these social determinants. It is not inequalities that kill people, as the report states; it is those who are responsible for these inequalities that kill people.

Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: a qualitative inquiry

“…Armstrong 2001;Bryant 2009;Coburn 2000;Marmot et al 1991;Navarro 2009;Raphael 2009;Wilkinson and Pickett 2010), their importance is widely recognized in official documents and reports. For instance, the WHO (2008) final report from the Commission on SDH emphasized the need to refocus public health activities from 'lifestyle choices' to issues of living conditions and social justice.…”

Using Freire’s Participatory Educational Method to Understand the Experience of Living With Chronic Illness in the Current Age of Globalization

“…Neoliberalism is a driving ideology that has been presented as the answer to a state's inefficiency through the creation of private markets that are most cost effective and consumer friendly (Navarro, 2009). The underlying principle of neoliberal health reform is that the private sector is more efficient than the public sector.…”

“…The underlying principle of neoliberal health reform is that the private sector is more efficient than the public sector. On the basis of this belief, neoliberal health reforms advocate for a reduction of the role of governments (Harvey, 2005;Navarro, 2009). In a neoliberal state, the function of government in public health is to regulate, whereas the private sector provides healthcare services (Homedes & Ugalde, 2005).…”

“…These aspects include unhealthy diet, tobacco use, insufficient physical activity, and the harmful use of alcohol and drugs (WHO, 2013). Open conditions for trade and foreign investment carry economic benefits but also encourage unhealthy lifestyles (Navarro, 2009). Multinational companies in the tobacco, sugar, and other food sectors have diverted attention from the need to address consumption patterns that produce chronic diseases to the economic and social effects for nations and companies that result from the low consumption of their products (Yach & Beaglehole, 2004).…”

Health sector reform and social determinants of health: building up theoretical and methodological interconnections to approach complex global challenges

“…Authors studying both themes in Mexico and Brazil see the role of expert communities that uses a considerable array of cognitive skills and scientific influence to implement such policy processes 10 . In this context, Buss and Pellegrini Filho emphasizes the importance of the Social Determinants Commission which has been institutionalized in Brazil since 2006 11 , and Navarro ironically points out the European experience for being less critical in regard to political perspectives of SDH 12 . The role of experts dealing with this highly contradictory policy area has long been analysed in an effort to understand the influence of science and these players beyond the academic sphere.…”