The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

BMC Public Health

Gwyneth M Jolley¹  Ronald Labonté⁴  Angela Lawless¹  Toby Freeman¹  David G Legge²  Frances E Baum³ 

[1] South Australian Community Health Research Unit, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia;School of Public Health & Human Bioscience, La Trobe University, 215 Franklin Street, Melbourne, Victoria 3000, Australia;Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia;University of Ottawa, Institute of Population Health, 1 Stewart Street, Ottawa, Ontario K1N 6N5, Canada

关键词: Aboriginal health;    Community health;    Health equity;    Social determinants of health;    Health promotion;    Primary health care;   

Others  :  1162221
DOI  :  10.1186/1471-2458-13-460

 received in 2013-01-16, accepted in 2013-04-30,  发布年份 2013

【 摘 要 】

Background

The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia.

Methods

Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government.

Results

While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services’ responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse “dilemmatic space” in their work.

Conclusions

The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health’s recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value of community control of PHC services and the types of policy, resource and managerial environments that support action on social determinants is warranted by this study’s findings.

【 授权许可】

   
2013 Baum et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization: Rio Political Declaration on Social Determinants of Health. Rio de Janeiro, Brazil: World Health Organization; 2011.
• [2]United Nations: UN Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. New York: General Assembly, United Nations; 2011.
• [3]World Health Organization: Ottawa charter for health promotion. Health Promot 1986, 1(4):i-v.
• [4]Catford J: Health promotion. In Understanding Health. Edited by Keleher H, MacDougall C. Melbourne: Oxford University Press; 2011:47-66.
• [5]Hoadley JS: The rise and fall of the basic needs approach. Cooperation Conflict 1981, 16:149-164.
• [6]Werner D, Sanders D, Weston J, Babb S, Rodriguez B: Questioning the solution: The politics of primary health care and child survival; with an in depth critique of Oral Rehydration Therapy. Palo Alto: Healthwrights; 1997.
• [7]Newell KW: Health by the people. Geneva, Switzerland: World Health Organization; 1975.
• [8]Foley G: Aboriginal community controlled health services: a short history. Aboriginal Health Project Inf Bull 1982, 2:13-15.
• [9]World Health Organization: Declaration of Alma-Ata, International Conference on Primary Health Care, USSR, 6–12 September. Alma Ata: World Health Organization; 1978.
• [10]Baum F: The New Public Health. 3rd edition. Melbourne: Oxford University Press; 2008.
• [11]MacDonald JJ: Primary health care: Medicine in its place. London: Earthscan; 1992.
• [12]Sanders D: The Struggle for Health: Medicine and the Politics of Underdevelopment. London: Macmillan; 1985.
• [13]Engels F: The Conditions of the Working Class in England. New York: Oxford University Press; 1993. [1845]
• [14]Waitzkin H: The social origins of illness: A neglected history. Int J Health Sci 1981, 11(1):77-103.
• [15]Allende S: Chile's medical-social reality-1939 (excerpts). Soc Med 2006, 1:151-155.
• [16]Navarro V (Ed): The Political Economy of Social Inequalities. Consequences for Health and Quality of Life. New York: Baywood Publishing Co; 2002.
• [17]Walsh JA, Warren KS: Selective primary health care — an interim strategy for disease control in developing countries. N Engl J Med 1979, 301:967-974. November 1, 1979
• [18]Underwood P, Owen A, Winkler R: Replacing the clockwork model of medicine. Community Health Stud 1986, 10(3):275-283.
• [19]Foucault M: The birth of the clinic: An archeology of medical perception. New York: Pantheon; 1973.
• [20]Illich I: Medical nemesis. London: Caldar and Boyars; 1975.
• [21]Tesh S: Hidden Arguments: Political Ideology and Disease Prevention Policy. New Brunswick, NJ: Rutgers University Press; 1988.
• [22]Duckett SJ: The Australian health care system. 3rd edition. Melbourne: Oxford University Press; 2007.
• [23]Banerji D: A fundamental shift in the approach to international health by WHO, UNICEF, and the World Bank: Instances of the practice of "intellectual fascism" and totalitarianism in some Asian countries. In The Political Economy of Social Inequalities Consequences for Health and Quality of Life. Edited by Navarro V. New York: Baywood Publishing Company; 2002.
• [24]World Health Organization: The world health report: Primary health care now more than ever. Geneva, Switzerland: WHO; 2008.
• [25]World Health Organization: Noncommunicable Diseases Country Profiles 2011. Geneva, Switzerland: WHO; 2011.
• [26]Cornia GA: Globalization and health: Results and opinions. Bull World Health Organ 2001, 79:834-841.
• [27]Labonte R, Schrecker T, Sanders D, Meeus W: Fatal indifference: The G8 and global health. Cape Town, South Africa: University of Cape Town Press / IDRC Books; 2004.
• [28]Wade RH: Is globalization reducing poverty and inequality? World Dev 2004, 32:567-589.
• [29]Fran B: Primary Health Care: can the dream be revived? Development in Practice 2003, 13, 5:515-519.
• [30]Baum F, Sanders DM: Ottawa 25 years on: a more radical agenda for health equity is still required. Health Promot Int 2011, 26(Suppl 2):ii253-257.
• [31]Keleher H: Why primary health care offers a more comprehensive approach for tackling health inequities than primary care. Aust J Prim Health 2001, 7:57-61.
• [32]Hunter BD, Neiger B, West J: The importance of addressing social determinants of health at the local level: the case for social capital. Health Soc Care Community 2011, 19(5):522-530.
• [33]Rogers W, Veale B: Primary health care and general practice: A scoping report. Adelaide, SA: Department of General Practice, Flinders University; 2000.
• [34]Hoggett P, Mayo M, Miller C: The dilemmas of development work: Ethical challenges in regeneration. Bristol, UK: Policy Press; 2009.
• [35]Hurley C, Baum F, Johns J, Labonte R: Comprehensive primary health care in australia: findings from a narrative review of the literature. Australas Med J 2010, 1:147-152.
• [36]Labonte R, Sanders D, Baum F, Schaay N, Packer C, Laplante D, Vega-Romero R, Viswanatha V, Barten F, Hurley C: Implementation, effectiveness and political context of comprehensive primary health care: preliminary findings of a global literature review. Aust J Prim Health 2008, 14(3):58-67.
• [37]Broom DH: Damned if we do: Contradictions in women's health care. North Sydney: Allen & Unwin; 1991.
• [38]Legge D, Wilson G, Butler P, Wright M, McBride T, Attewell R: Best practice in primary health care. Aust J Prim Health - Interchange 1996, 2(1):22-26.
• [39]Baum F, Fry D, Lennie I: Community Health Policy and Practice in Australia. Sydney: Pluto Press in conjunction with Australian Community Health Association; 1992.
• [40]Baum F (Ed): Health for All: The South Australian Experience. Adelaide, SA: Wakefield Press; 1995.
• [41]Lefkowitz B: Community health centres: A movement and the people who made it happen. Piscataway, NJ: Rutgers University Press; 2007.
• [42]Giddens A: Modernity and self-identity: Self and society in the late modern age. Cambridge: Polity; 1991.
• [43]Giddens A: The consequences of modernity. Cambridge: Polity; 1990.
• [44]National Hospital and Health Services Commission: A Community Health Program for Australia. Canberra: AGPS; 1973.
• [45]Milio N: Next steps in community health policy: Matching rhetoric and reality. Community Health Stud 1983, 7(2):185-192.
• [46]Owen A, Lennie I: Health for all and community health. In Community health: Policy and practice in Australia. Edited by Baum F, Fry D, Lennie I. Sydney: Pluto Press; 1992:6-27.
• [47]Anderson I: Powers of health. Arena Mag 1994, 11:32-36.
• [48]Tremblay MA: The key informant technique: A non-ethnographic application. In Field research: A sourcebook and field manual. Edited by Burgess RG. London: Allen and Unwin; 1982:98-104.
• [49]Morse JN, Barrett M, Mayan M, Olson K, Spiers J: Verification strategies for establishing reliability and validity in qualitative research. Int J Qualitative Methods 2002, 1:13-22. Article 2
• [50]Mason J: Qualitative researching. London: Sage; 2002.
• [51]Patton MQ: Qualitative evaluation and research methods. 2nd edition. Thousand Oaks, CA: Sage; 1990.
• [52]Community Foodies. http://www.communityfoodies.com/ webcite
• [53]Warin M, Baum F, Kalucy E, Murray C, Veale B: The power of place: space and time in women's and community health centres in South Australia. Soc Sci Med 2000, 50:1863-1875.
• [54]Martin P, Rosenberg J: Coles tackles alcohol problem with a floor price of $8 a bottle. In Sydney Morning Herald. Sydney; 2011. http://www.smh.com.au/national/coles-tackles-alcohol-problem-with-a-floor-price-of-8-a-bottle-20110623-1ghhg.html webcite
• [55]Gibson S: The language of the right: sex education debates in South Australia. Sex Educ 2007, 7(3):239-250.
• [56]Baum F, Lawless A, Williams C: Health in All Policies from international ideas to local implementation: policies, systems and organizations. In Health Promotion and the Policy Process: Practical and Critical Theories. Edited by Clavier C, De Leeuw E. Oxford: Oxford University Press, forthcoming; 2013.
• [57]Sanderson C, Alexander K: Community Health Services planning for health. In Health for All: The South Australian Experience. Edited by Baum F. Adelaide, SA: Wakefield Press; 1995.
• [58]Commission on Social Determinants of Health: Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organization; 2008.
• [59]Labonte R: Heart health inequalities in Canada: Models, theory and planning. Health Promot Int 1992, 7(2):119-127.
• [60]Dwyer JM, Lavoie J, O’Donnell K, Marlina U, Sullivan P: Contracting for indigenous health care: towards mutual accountability. Aust J Public Adm 2011, 70(1):34-46.
• [61]Bartlett B, Boffa J: The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy. Aust J Prim Health 2005, 11:53-61.
• [62]Baum F, Sanders D: Can health promotion and primary health care achieve health for all without a return to their more radical agenda? Health Promot Int 1995, 10(2):149-160.
• [63]Laris P: Boards of directors of community health services. In Health for all: The South Australian experience. Edited by Baum F. Kent Town, SA: Wakefield Press; 1995.
• [64]McCann W: Review of Non-Hospital Based Services. Adelaide, SA: Government of South Australia; 2012.