Systems change for the social determinants of health

BMC Public Health

Research Article

Brad Crammond¹  Gemma Carey² 

[1] Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia;Regulatory Institutions Network, College of Asia and the Pacific, The Australian National University, Canberra, ACT, Australia;

关键词: Health Inequality;    Social Determinant;    System Lens;    Intervention Point;    Leverage Point;   

DOI  :  10.1186/s12889-015-1979-8

 received in 2014-11-27, accepted in 2015-06-26,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundInequalities in the distribution of the social determinants of health are now a widely recognised problem, seen as requiring immediate and significant action (CSDH. Closing the Gap in a Generation. Geneva: WHO; 2008; Marmot M. Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalitites inEngland Post-2010. London; 2010). Despite recommendations for action on the social determinants of health dating back to the 1980s, inequalities in many countries continue to grow. In this paper we provide an analysis of recommendations from major social determinants of health reports using the concept of ‘system leverage points’. Increasingly, powerful and effective action on the social determinants of health is conceptualised as that which targets government action on the non-health issues which drive health outcomes.MethodsRecommendations for action from 6 major national reports on the social determinants of health were sourced. Recommendations from each report were coded against two frameworks: Johnston et al’s recently developed Intervention Level Framework (ILF) and Meadow’s seminal ‘12 places to intervene in a system’ (Johnston LM, Matteson CL, Finegood DT. Systems Science and Obesity Policy: A Novel Framework forAnalyzing and Rethinking Population-Level Planning. American journal of public health. 2014;(0):e1-e9; Meadows D. Thinking in Systems. USA: Sustainability Institute; 1999) (N = 166).ResultsOur analysis found several major changes over time to the types of recommendations being made, including a shift towards paradigmatic change and away from individual interventions. Results from Meadow’s framework revealed a number of potentially powerful system intervention points that are currently underutilised in public health thinking regarding action on the social determinants of health.ConclusionWhen viewed through a systems lens, it is evident that the power of an intervention comes not from where it is targeted, but rather how it works to create change within the system. This means that efforts targeted at government policy can have only limited effectiveness if they are aimed at changing relatively weak leverage points. Our analysis raises further (and more nuanced) questions about what effective action on the social determinants of health looks like.

【 授权许可】

CC BY   
© Carey and Crammond. 2015