Why Social (Political, Economic, Cultural, Ecological) Determinants of Health? Part 1: Background of a Contested Construct

Abstract

This article is the first half of a 2-part essay on the Social Determinants of Health (SDOH) as a field of scientific inquiry and theoretical framework, exploring its historical roots, current applications, and the controversies that surround it. Part 1 (this article) discusses the background and rationale of the SDOH framework, whilst part 2 (forthcoming) will analyze the current alternatives to this framework. The authors analyze the debate surrounding the contested term “social” in the field of health equity, through a clarification of the terms “social” and “social systems” and providing an alternative model through realist semantics and ethics. Despite the misunderstandings of the term “social,” the authors argue that SDOH remains a useful umbrella term to capture the political, economic, cultural, and ecological determinants of health. Through this essay, the authors outline the reasons behind our decision to change this journal's title from International Journal of Health Services to International Journal of Social Determinants of Health and Health Services.

Understanding Health Inequalities Research Capacities: Insights and Recommendations From Comparing Two High Income Settings

“…1,2 Generating evidence on HI is essential to raise awareness about their existence, describe and monitor their evolution over time, analyze their underlying causes, and, ideally, inform the design and implementation of interventions aiming to improve health outcomes for all social groups in a given population. 3,4…”

“…1,2 Generating evidence on HI is essential to raise awareness about their existence, describe and monitor their evolution over time, analyze their underlying causes, and, ideally, inform the design and implementation of interventions aiming to improve health outcomes for all social groups in a given population. 3,4 For instance, during the COVID-19 pandemic urgent questions arose regarding how to quickly and equitably respond, and what were the diverse health, social, and economic effects on individuals and communities. [5][6][7] Contextualized health-equity oriented analyses based on empirical evidence were needed to address these questions and build comprehensive assessments of the causes, distribution and impact of these events.…”

Intersectionality on the perception of health in two cross-national surveys (WVS and EVS)

“…It addresses the problem of social inequalities, especially those between men and women and among women [ [6] , [7] , [8] , [9] ]. Quantitative intersectional analysis has focused on the intercategorical level of analysis [ [10] , [11] , [12] , [13] ], highlighting the multiple simultaneous interactions and patterns of inequalities in health perceptions [ 14 , 15 ]. As the World Health Organization points out, social inequalities in health’ perceptions are rooted in inequalities in living conditions [ 16 ].…”