title: Getting to the root of the problem: health promotion strategies to address the social determinants of health.
abstract: Although extensive research shows that the social determinants of health influence the distribution and course of chronic diseases, there is little programming in public health that addresses the social determinants as a disease prevention strategy. This paper discusses different types of health promotion initiatives and differentiates them based on whether they attempt to impact intermediate (environmental) determinants of health or structural determinants of health. We argue for the importance of programming targeted at the structural determinants as opposed to programming targeted solely at the immediate environment. Specifically, the former has more potential to create significant improvements in health, contribute to long-term social change and increase health equity. We urge public health leaders to take this distinction into consideration during public health program planning, and to build capacity in the public health workforce to tackle structural mechanisms that lead to poor health and health inequities.
authors.affiliation: School of Health Sciences, Faculty of Health Sciences, University of Western Ontario, London, ON. dana.gore@gmail.com
authors.forename: Dana M
authors.initials: DM
authors.lastname: Gore
authors.forename: Anita R
authors.initials: AR
authors.lastname: Kothari
mesh_terms: D002170:Canada; D002908:Chronic Disease / Q000517:prevention & control*; D004782:Environmental Health; D006293:Health Promotion / Q000379:methods*; D054624:Health Status Disparities; D006801:Humans; D015397:Program Evaluation; D015980:Public Health Practice; D012922:Social Change; D012931:Social Environment; D012959:Socioeconomic Factors
keywords: Chronic disease; health promotion; public health practice; social change; social conditions; social environment