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.
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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