Social Determinants of Health Forum, July 2012, University of Sydney
Summary of a forum on Social Determinants of Health: Innovations in Policy and Practice, held at the University of Sydney 27 July 2012.
- 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 convened by Deborah Lupton of the Department of Sociology and Social Policy.
- Speaker profiles are below:
- OpeningOpening remarks were made by 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.Professor Steve Simpson: Introduction and WelcomeThe first speaker was Professor Steve Simpson, Director of the Charles Perkins Centre. Steve described the aims of the Centre, which is directed at reducing the burden of obesity, diabetes and cardiovascular disease in the Australian population. He noted that the Centre will bring together researchers from many faculties in the university with its focus on multidisciplinary and collaborative work. 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.
Associate Professor Peter Sainsbury: Social Determinants of Health: Setting the ContextThe 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 the main message of his talk was 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 those large corporations that care little for people's health.
- Deb Wildgoose and Isobel Ludford, Health in All Policies Unit, South Australia Health: Tackling the Social Determinants of Health through Health in All Policies: South Australia's ExperienceThe 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.
- Case StudiesThe 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. The study has recruited a cohort of 400 young people aged 10 to 12 and is using urine and blood samples to measure their hormone levels. Importantly the study is also focusing on social relationships and socio-economic status of the cohort in the attempt to identify how these influence young people's health and wellbeing.
- 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.In his talk Matt spoke about the difficulties in implementing strategies facilitating greater physical activity (such as cycling to work or using public transport rather than driving) 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 noted 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. He remarked on the irony that such foods as soft drinks and chips are readily available and the same price as in urban areas, but fresh foods are far more expensive in many of the grocery stores located in these communities. 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. John said that he preferred the salutogenic rather than the pathogenic model: that is, a focus on achieving good health rather than avoiding or dealing with illness and disease. 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.
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- Stacy CarterHi Deborah: great to see you circulating info from this event more widely. Wanted to add to what you've written re: my presentation. I've found Powers and Faden...Hi Deborah: great to see you circulating info from this event more widely. Wanted to add to what you've written re: my presentation. I've found Powers and Faden's theory useful because it's normatively precise - much moreso than commonplace general statements about equity for all. You're absolutely right that they see a good society as a just society, but of course ‘justice’ can mean many things. They provide a detailed theorisation of justice focused on sufficiency of wellbeing. (Sufficiency is a technical term meaning something like “wanting everyone to reach a minimum threshold, but not being so concerned about what happens above that.”) To re-use the quote I showed on Friday, Powers and Faden argue that: "justice is concerned with securing and maintaining the social conditions necessary for a sufficient level of wellbeing in all of its essential dimensions for everyone.” (p.50) Wellbeing has 6 dimensions in their theory: only one of these is health. The other 5 are attachment, respect, self-determination, personal security and reasoning. Each of these has independent moral significance – we have something like a fundamental human right to each of them. When 1 or more of these dimensions is absent, it’s likely that an injustice is occurring. Social determinants are the conditions that make wellbeing possible. Clusters or cascades of negative social determinants are likely to undermine 1 or more dimensions of wellbeing, creating "densely woven, systematic patterns of disadvantage." Such patterns are of the most urgent moral concern, because it would require extraordinary good luck or heroic efforts for an individual to escape them. So who should address these urgent moral concerns? Public institutions have a special obligation to work towards justice; public health is a public institution, so it is thus obliged. This means that public health should be working towards “securing and maintaining the social conditions necessary for a sufficient level of wellbeing in all of its essential dimensions for everyone.” This encourages working on social determinants; it also precludes interventions which would emphasise one dimension of wellbeing but undermine others (e.g. try to decrease people’s BMI in a way that would undermine their self-respect and the respect they get from others). The precision of their definition of justice allows us both to imagine a better world, and to diagnose particularly urgent moral obligations. Was great to have a chance to briefly share their theory with the folks in the audience, and especially to hear from others. Thanks for your contribution to organising the day. more2012-08-01T08:39:54.674Z