(A Conceptual Framework for Action on the Social Determinants of Health Discussion, 2007) STRUCTURAL DETERMINANTS OF HEALTH Graham observes that the concept of ‘social determinants of health’ has acquired a dual meaning, referring both to the social factors promoting and undermining the health of individuals and populations and to the social processes underlying the unequal distribution of these factors between groups occupying unequal positions in society. The central concept of ‘social determinants’ thus remains ambiguous, referring simultaneously to the determinants of health and to the determinants of inequalities in health. Graham notes that: "using a single term to refer to both the social factors influencing health and the social processes shaping their social distribution would not be problematic if the main determinants of health—like living standards, environmental influences, and health behaviors—were equally distributed between socioeconomic groups". But the evidence points to marked socioeconomic differences in access to material resources, health-promoting resources, and in exposure to risk factors. Furthermore, policies associated with positive trends in health determinants (e.g., a rise in living standards and a decline in smoking) have also been associated with persistent socioeconomic disparities in the distribution of these determinants (marked socioeconomic differences in living standards and smoking rates). 103 We have attempted to resolve this linguistic ambiguity by introducing additional differentiations within the field of concepts conventionally included under the heading ‘social determinants’. We adopt the term ‘structural determinants’ to refer specifically to the components of people’s socioeconomic position. Structural determinants, combined with the main features of the socioeconomic and political context described above, together constitute what we call the social determinants of health inequities. This concept corresponds to Graham’s notion of the ‘social processes shaping the distribution’ of downstream social determinants. When referring to the more downstream factors, we will use the term ‘intermediary determinants of health’.
Posted on: Mon, 05 Aug 2013 10:57:05 +0000
Trending Topics
Recently Viewed Topics
© 2015