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Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program.

Spiegel JM, Breilh J, Yassi A - Global Health (2015)

Bottom Line: In this region marked by pronounced inequity, context-sensitive concepts such as "collective health" and "critical epidemiology" have been prominent, albeit with limited acknowledgement by the Global North.We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts.It follows that "reverse innovation" must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.

View Article: PubMed Central - PubMed

Affiliation: School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada. jerry.spiegel@ubc.ca.

ABSTRACT

Background: Focus on "social determinants of health" provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of "risk factors" related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of "social determination of health" has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis.

Discussion: In this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as "collective health" and "critical epidemiology" have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the "4 S" elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth).

Conclusions: We argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that "reverse innovation" must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.

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Framing social determination versus social determinant orientation.
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Fig1: Framing social determination versus social determinant orientation.

Mentions: In the SDH orientation articulated within mainstream epidemiology, the driving questions that target the relationship between social determinants and health equity can be characterized as i) “what factors can be distinguished” as exerting influences on health, and ii) “what are the associations with health”. In common with the many other critics mentioned above, our conceptualization of the social determination approach sees these considerations as necessary but not sufficient to dynamically consider driving influences as well as how affected social actors can engage with the normative position of pursuing social justice and health equity. In other words, as illustrated by Figure 1, our SDnH approach more directly promotes consideration of iii) processes that may be supportive of “emancipation” and health equity (potentially challenging hegemonic status quo social relations); and iv) the forces that drive and influence relationships and determinants themselves, over and above a role in “determining the distribution of these causes between more and less advantaged groups” as per the SDH conceptual framing [15].Figure 1


Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program.

Spiegel JM, Breilh J, Yassi A - Global Health (2015)

Framing social determination versus social determinant orientation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4353467&req=5

Fig1: Framing social determination versus social determinant orientation.
Mentions: In the SDH orientation articulated within mainstream epidemiology, the driving questions that target the relationship between social determinants and health equity can be characterized as i) “what factors can be distinguished” as exerting influences on health, and ii) “what are the associations with health”. In common with the many other critics mentioned above, our conceptualization of the social determination approach sees these considerations as necessary but not sufficient to dynamically consider driving influences as well as how affected social actors can engage with the normative position of pursuing social justice and health equity. In other words, as illustrated by Figure 1, our SDnH approach more directly promotes consideration of iii) processes that may be supportive of “emancipation” and health equity (potentially challenging hegemonic status quo social relations); and iv) the forces that drive and influence relationships and determinants themselves, over and above a role in “determining the distribution of these causes between more and less advantaged groups” as per the SDH conceptual framing [15].Figure 1

Bottom Line: In this region marked by pronounced inequity, context-sensitive concepts such as "collective health" and "critical epidemiology" have been prominent, albeit with limited acknowledgement by the Global North.We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts.It follows that "reverse innovation" must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.

View Article: PubMed Central - PubMed

Affiliation: School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada. jerry.spiegel@ubc.ca.

ABSTRACT

Background: Focus on "social determinants of health" provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of "risk factors" related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of "social determination of health" has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis.

Discussion: In this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as "collective health" and "critical epidemiology" have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the "4 S" elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth).

Conclusions: We argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that "reverse innovation" must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.

Show MeSH
Related in: MedlinePlus