Essay on Health Equity

9276 Words Aug 4th, 2015 38 Pages
Nursing in 3D: Diversity, Disparities, and Social Determinants

The Social Determinants of Health: It’s
Time to Consider the Causes of the Causes

Paula Braveman, MD, MPHa
Laura Gottlieb, MD, MPHb

During the past two decades, the public health community’s attention has been drawn increasingly to the social determinants of health (SDH)—the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use “medical care” rather than “health care” to refer to clinical services, to avoid potential confusion between “health” and “health care.” The World Health Organization’s Commission on the Social Determinants of Health has defined SDH as “the conditions in which people
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©2014 Association of Schools and Programs of Public Health

Public Health Reports / 2014 Supplement 2 / Volume 129

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20  Nursing in 3D: Diversity, Disparities, and Social Determinants

A large and compelling body of evidence has accumulated, particularly during the last two decades, that reveals a powerful role for social factors—apart from medical care—in shaping health across a wide range of health indicators, settings, and populations.1–16 This evidence does not deny that medical care influences health; rather, it indicates that medical care is not the only influence on health and suggests that the effects of medical care may be more limited than commonly thought, particularly in determining who becomes sick or injured in the first place.4,6,7,17,18 The relationships between social factors and health, however, are not simple, and there are active controversies regarding the strength of the evidence supporting a causal role of some social factors. Meanwhile, researchers increasingly are calling into question the appropriateness of traditional criteria for assessing the evidence.17,19–22
The limits of medical care are illustrated by the work of the Scottish physician, Thomas McKeown, who studied death

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