Reporting on a recent forum on health inequalities and the social determinants of health
It’s fascinating to watch the emergence in the health sector of those who might be considered “informed citizen journalists”. In my view, these ICJs are not simply engaging with digital media as a channel for advocacy for their particular interest or area, but are playing a wider role.
Within hours of the Olympics opening, she had compiled this Storify providing reportage and analysis of the focus on the NHS in the opening ceremony. It’s worth checking just to see the priceless image of a grimacing Boris Johnson and David Cameron, apparently in response to the homage to the NHS.
In the article below, Lupton reports on a recent forum at the University of Sydney, bringing together researchers and others with an interest in the social determinants of health, and you can also read more in her Storify version.
Amongst other things, speakers suggested that organisations such as GetUp should be enlisted in efforts to tackle social and health inequities, and described the wider social impact upon Indigenous communities of the lack of local access to dialysis.
Some insights into the “gargantuan” task of addressing social, economic and health inequalities
Deborah Lupton writes:
The Social Determinants of Health forum was held on 27 July at the University of Sydney. It was sponsored by the Sydney Health Policy Network and the Charles Perkins Centre, both of the University of Sydney, and the Sydney Health & Society Group, an inter-university group.
Professor Steve Leeder, Director of the Menzies Centre for Health Policy at the University of Sydney and Chair of the Sydney Health Policy Network Steering Committee opened the forum. He was followed by Professor Steve Simpson, Director of the Charles Perkins Centre, who described the aims of the Centre, which is directed at reducing the burden of obesity, diabetes and cardiovascular disease in the Australian population.
Steve Simpson noted that one of the Centre’s identified research domains is the social and economic contexts of biology and another is the design and implementation of solutions. It is in relation to these research domains in particular that awareness of the social determinants of health will be integral to research.
The next speaker was Associate Professor Peter Sainsbury, the Director of Population Health in South Western Sydney and Sydney local health districts. Peter is a self-described life-long socialist, and in his talk he strongly emphasised the importance of being political and working to reduce oppression and disadvantage. Peter said that he wants to focus on the gradient that shows a strong relationship between low income and poorer health and longevity.
How to direct programs at addressing and reducing this gradient?
Peter argued that systems and complexity theories may have something to offer, because they are able to acknowledge the highly complex nature of the relationship between health, wellbeing and social factors. He argued for the importance of identifying agencies and organisations that can help in the project of addressing social inquities, such as GetUp, as well as working to act against the large corporations that care little for people’s health.
The next two speakers presented a joint talk on the Health in All Policies in South Australia. Deb Wildgoose and Isobel Ludford are project officers who both work for the South Australian Health department. They spoke of their experiences of being involved with implementing the Health for All Policies strategy. This strategy was developed in a meeting in 2010 and drew on the wisdom of Professor Illona Kickbusch, a well-known public health academic, who was sponsored by the South Australian government to visit Adelaide as a Thinker in Residence.
Deb and Isobel said that the Health for All Policies positions the Health department as a facilitator and enabler rather than a self-appointed change agent. It focuses on encouraging all government departments and agencies, even those that are not specifically directed at health issues, to realise how their policies and programs are related to health.
The forum was then addressed by six speakers, each of whom was given seven minutes to present a case study relating to the social determinants of health.
Dr Catherine Hawke from the University of Sydney’s School of Rural Health spoke about the ARCHER longitudinal study conducted in rural New South Wales looking at adolescents and the role of hormones and social factors in contributing to their health status.
Matt Faber is the Manager of the Bus Light Rail Active Transport Strategy, an initiative of the New South Wales government as part of its Long Term Transport Master Plan. He spoke about the difficulties in implementing strategies facilitating greater physical activity in a political climate in which governments change and funding for infrastructure such as extensions of existing bike tracks is not always forthcoming.
Matt called for health professionals and government policy-makers and administrators to work together to achieve their common aims. Given the difficulties of implementing and funding infrastructure projects, Matt identified small, incremental change as something that public health professionals should also focus on, while at the same time working with government on ‘big picture’ infrastructure reforms to achieve good health outcomes.
Professor Alan Cass, a Senior Director from the George Institute for Global Health at the University of Sydney, followed with a case study on Indigenous health. Alan talked about the difficulties experienced in providing fresh food such as vegetables and fruit in remote areas for Indigenous people which was both in high quality condition and affordable.
Alan also commented on the disruption caused to Indigenous communities by removing elders for health care elsewhere, such as dialysis, because of lack of treatment facilities for chronic illness in the community.
Dr Stacy Carter, a public health ethicist from the University of Sydney’s Centre for Values, Ethics and the Law in Medicine, used her brief time to introduce the audience to a book on public health ethics that she has found helpful in her own thinking. Titled Social Justice: the Moral Foundations of Public Health and Health Policy, the book contends that a good society is a just society, and that public health efforts should be directed at achieving equity for all.
Justice is about securing and maintaining the social conditions conducive to good health and wellbeing for all members of society. Everyone, including public health workers and researchers, need to contribute to achieving this goal and take collective responsibility for addressing social and economic disadvantage, which in turn will promote good health.
Professor John MacDonald, Director of the Men’s Health Information and Resource Centre at the University of Western Sydney, then gave a case study on men’s health. He argued for the importance of recognising how dominant concepts of masculinity shaped men’s health beliefs, behaviours and experiences. John gave the example of the Men’s Sheds movement in which he is involved as a successful strategy for helping older men in particular achieve better social relationships, health and wellbeing by giving them a place to meet and a sense of purpose.
The last case study was presented by Dr Jo Mitchell, Acting Director of the Centre for Population Health, a joint centre of the NSW Ministry of Health and the University of New South Wales. She spoke about the Healthy Built Environments program, which has been funded by NSW Health for five years. This program focuses on how the built environment affects health and wellbeing and provides leadership and advocacy, fostering training and education and encouraging collaborative research between planning and health professionals.
The forum was concluded with a panel discussion including all the speakers, facilitated by Dr Rosalie Pockett, convenor of the Social Determinants of Health Special Interest Group in the Sydney Health Policy Network and a summary of the day’s main contributions by Rosalie and Steve Leeder.
As was evident from the forum’s dicussions, addressing the social and economic inequalities that underpin the social determinants of health is a gargantuan task.
Many of the speakers are engaged at the coal-face of attempting to alleviate inequality as part of achieving better health for all. They have realised that ameliorating health status for disadvantaged groups – reducing the steepness of the gradient that shows such a strong relationship between income and health – goes well beyond the concerns of departments of health.
Ethicists and social scientists also have an important role to play in drawing attention to the broader issue of social justice as it relates to public health policy, the possible negative consequences of a focus on individual behaviour rather than on the social structural reasons for ill-health and premature mortality and the continuing divide between the poor and the well-off in countries such as Australia.
These important issues will continue to be addressed by the Social Determinants of Health Special Interest Group, which brings together a diverse range of practitioners and researchers.