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INFRASTRUCTURE

by Aruni Areti

 

Keywords: infrastructure, engineering, metaphors, social determinants of health, inequality, policy, social network, material environments, causal relationship, syndemic 

ABSTRACT

Infrastructure is often defined as the physical and organizational structures, facilities, and agencies (e.g. buildings, roads, power supplies) that are required in order to upstart and manage a society or enterprise. The American College of Physicians establish that within healthcare, infrastructure is made up of the physical environment, workforce, technology and information systems, and agencies that assess and respond to public health needs (Kline 2012). Under this model, infrastructure serves as the medium in which healthcare is developed and delivered. Moreover, public health scholars have established infrastructure as a foundational pillar for promoting improved standards of care and wellbeing for all patients. 

Research has found a causal relationship between infrastructure development and mitigation of social determinants of health; however, there is a lack of understanding on how this is enacted (Bajar and Rajeev 2016). Such casual associations become detrimental as they oversimplify methods of improving health equity. In which case, infrastructure becomes a misguided metaphor that assumes social life can be simply treated as an engineering problem. 

Barriers to health (i.e. trust & access) are directly related to several aspects of one's life (i.e. education & income), but each one needs to be considered differently because their impact on people's lives are differently manifested. There is no linear path as to how an issue comes up and is addressed (Weinstein et al. 2017). Therefore, it is imperative that research studies how social networks within a material environment work together to influence the effects of social determinants of health & structural inequalities (Latham and Layton 2019). Rather than statically measuring the components of an infrastructure model, research requires a dynamic approach to investigating how infrastructure policies affect growth and inequality within a specific community. 

The literature review analyzes why scholars must shift their attention to studying the social experiences within a built environment in order to establish a syndemic approach to health inequality. This approach requires critiquing conventional measures of infrastructure development within policies and previous public health literature and promoting a holistic understanding of how both structural and social networks interact with biological conditions. 

References

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Bajar, Sumedha, and Meenaksh Rajeev. 2016. “The Impact of Infrastructure Provisioning on Inequality in India: Does the Level of Development Matter?” Journal of Comparative Asian Development, April, 122–55.

Calderón, César, and Luis Servén. 2014. “Infrastructure, Growth, and Inequality: An Overview.” Policy Research Working Papers, October. 

De Groot, Jiska, and Charlotte Lemanski. 2020. “COVID-19 Responses: Infrastructure Inequality and Privileged Capacity to Transform Everyday Life in South Africa.” Environment and Urbanization 33 (1): 255–72. 

Douthit , Nathan T, and Haimanot Kasahun Alemu. 2016. “Social Determinants of Health: Poverty, National Infrastructure and Investment.” BMJ Case Report, June. 

Fazalullasha, Fatima, Jillian Taras, Julia Morinis, Leo Levin, Karima Karmali, Barbara Neilson, Barbara Muskat, et al. 2014. “From Office Tools to Community Supports: The Need for Infrastructure to Address the Social Determinants of Health in Paediatric Practice.” Paediatrics & Child Health 19 (4): 195–99. doi:10.1093/pch/19.4.195. 

Goulbourne, Taylor, and Itzhak Yanovitzky. 2021. “The Communication Infrastructure as a Social Determinant of Health: Implications for Health Policymaking and Practice.” The Milbank Quarterly 99 (1): 24–40. 

Graham, Hilary. 2002. “Building an Inter-Disciplinary Science of Health Inequalities: the Example of Lifecourse Research.” Social Science & Medicine 55 (11): 2005–16. 

Kawachi, I, B P Kennedy, K Lochner, and D Prothrow-Stith. 1997. “Social Capital, Income Inequality, and Mortality.” American Journal of Public Health 87 (9): 1491–98. 

Kline, Michelle. 2012. “Strengthening the Public Health Infrastructure in a Reformed Health Care System.” American College of Physicians;

Latham, Alan, and Jack Layton. 2019. “Social Infrastructure and the Public Life of Cities: Studying Urban Sociality and Public Spaces.” Geography Compass 13 (7). 

Luxon, Linda. 2015. “Infrastructure – the Key to Healthcare Improvement.” Future Hospital Journal 2 (1): 4–7. 

Navarro, Vicente, and Leiyu Shi. 2020. “The Political Context of Social Inequalities and Health.” The Political Economy of Social Inequalities, 403–18. 

Sharma, Amalesh, Sourav Bikash Borah, and Aditya C. Moses. 2021. “Responses to COVID-19: The Role of Governance, Healthcare Infrastructure, and Learning from Past Pandemics.” Journal of Business Research 122 (January): 597–607. 

Weinstein, James N., Amy Geller, Yamrot Negussie, and Alina Baciu. 2017. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press. 

Aruni Areti

Rice University '22

MRD | Research Assistant