Social

by Dr Gemma Carey

If you work in the community sector, you may have noticed the term “social determinants of health” creeping into conversation. The term comes from public health, and is rapidly gaining attention both internationally and here in Australia.

“Social determinants of health” is simply another name for the social problems that the community sector works to fix, such as housing, income insecurity, education and disadvantage.

Public health research has shown that these social issues are the primary cause behind health problems like cardiovascular disease, diabetes and obesity. This means that poor health is the result of social conditions that can’t be addressed by the health care system.

Interest in the social determinants has increased dramatically in the last year. 2013 saw the establishment of the Australian Social Determinants of Health Alliance and the Senate Inquiry into the Social Determinants of Health.

But what does the rise of the social determinants of health mean for the community sector?

The realisation that social issues create poor health brings a wider range of sectors and professionals to the table on issues of social disadvantage. With this also comes knowledge, expertise and resources.

Public health has an impressive history of public advocacy and policy change based on ground-breaking research. As Professor Robert Douglas reported on the Conversation, a recent public health study revealed that poverty has a greater impact on child development that the use of cocaine during pregnancy. This type of research packs a serious punch when it comes to advocating for social policy change.

In 2010, social determinants of health advocate Sir Michael Marmot released the Strategic Review of Health Inequalities in the UK. This report is one of the most comprehensive compilations of evidence on the effects of disadvantage on health and wellbeing ever created. Referred to as “ideology with evidence”, it is a must-read for the community sector.

Health is also the number one area of government spending, making up 19% of the budget. In comparison, welfare spending (including services delivered by the community sector and cash payments like Newstart) makes up just 0.004% of the government’s budget. Linking health to welfare and disadvantage creates new opportunities for resources and policy change.

Are there any risks for the sector?

Public health is undoubtedly a powerful ally. However, the rise of the social determinants of health also poses a number of risks for the sector.

Over the last few decades we have seen “health” expand to encompass an ever-growing number of social issues. The social determinants of health mean that all social issues are now the domain of health.

The community sector needs to be careful that it is not displaced by health advocates and practitioners. If health were to “take over” social determinants work, valuable knowledge from the community sector could be lost. Already, 36 of the 49 members of the Social Determinants of Health Alliance are health-based organisations.

While public health and the community sector now agree on the problem, this does not mean they agree on the solution. Social determinants of health researchers bring new evidence and fresh arguments to debates about social disadvantage, but they do not have the answers.

At the moment, public health professionals are advocating for “Health in All Policies”. This initiative is aimed at getting policy-makers to think about health when designing and implementing policy, and to avoid policies that will have negative impacts on health.

This seems reasonable on the surface, but will policy-makers in transport or employment care about health? Isn’t it rather presumptuous to think that health should trump other equally deserving issues? Social problems might impact health, but this doesn’t mean a health focus is the best way to fix them.

Public health and the community sector also work on different levels. Social determinants of health researchers tend to use statistical data to model the impact of issues – such as income – on the health of the population. However, this data has little direct relevance to the real lives of the individuals the community sector works with. This means that public health advocates are chasing major changes in policy without understanding how individuals can overcome social problems and improve their health.

What can the sector do?

In order to capitalise on what the social determinants of health offers, and minimise the threats, the sector needs to engage.

This means reading the research (such as the Review of Health Inequalities), engaging with public health researchers and joining the Social Determinants of Health Alliance.

By doing this, the community sector can help build vital links between population-based evidence and individual experiences of disadvantage.

Dr Gemma Carey is an Australian researcher with an interest in health equity and the social determinants of health. A paper she has co-authored, Help or hindrance? The social services sectors and the social determinants of health, is currently in press.