POLICY as keyword
by Sally Yan
Keywords: social determinants, social model of health policy, health inequities, health disparities, global health, ideology, neo-liberalism
Policy attention to social determinants of health (SDoH) has been delayed, periodic, politically- contingent, and superficial. The influence of poverty--a key social determinant of health--has been noted since the nineteenth century by scholars as varied as Virchow and Engels (Kunitz 2007). However, the incorporation of a social model of health into global policy did not come to fruition until the establishment of complex bureaucracies such as the World Health Organization in the 1950s, and the term “social determinants of health” did not exist until the 1970s (Irwin and Scali 2007).
Despite the centrality of a social model of health, which seeks to address non-medical factors to improve health, in the WHO’s founding vision, the influence of social determinants of health on global policy wavered in importance in the subsequent decades. Attention peaked during the Health for All campaign espoused by the 1978 Alma-Ata then fading through decades of international policies driven by neoliberalism (Irwin and Scali 2007). In the interim, although initially driven by an impetus for global equity, the concept of social determinants of health began to primarily persist mostly in the policies of the wealthy industrialized countries (Irwin and Scali 2007). Graham (2002) and other scholars argue that even in wealthy countries, policies futilely attempt to address singular social and behavioral factors rather than the systemic causes of social inequities. Although the WHO Commission on the Social Determinants of Health, operating from 2005-2008, aimed to mitigate some of these gaps and amplified scholarship on SDoH, its impact was ultimately limited (Irwin and Scali 2007; Kunitz 2007).
Since the last significant critical scholarship, the COVID-19 pandemic, arguably a syndemic whose impact is profoundly influenced by social determinants, has renewed policy attention to SDoH (Horton 2020). In the wake of the pandemic, this literature review aims to critically examine the history of social determinants of health and evaluate recent policies in the context of this history.
Graham, Hilary. 2004. “Social Determinants and Their Unequal Distribution: Clarifying Policy Understandings.” The Milbank Quarterly 82 (1): 101–24.
Horton, Richard. 2020. “Offline: COVID-19 Is Not a Pandemic.” The Lancet 396 (10255): 874.
Irwin, A., and E. Scali. 2007. “Action on the Social Determinants of Health: A Historical Perspective.” Global Public Health 2 (3): 235–56.
Kunitz, Stephen J. 2007. “Sex, Race and Social Role—History and the Social Determinants of Health.” International Journal of Epidemiology 36 (1): 3–10.