title: Health in global context; beyond the social determinants of health?
abstract: The rise of the social determinants of health (SDH) discourse on the basis of statistical evidence that correlates ill health to SDH and pictures causal pathways in comprehensive theoretical frameworks led to widespread awareness that health and health disparities are the outcome of complex pathways of interconnecting SDH. In this paper we explore whether and how SDH frameworks can be translated to effectively inform particular national health policies. To this end we identified major challenges for this translation followed by reflections on ways to overcome them. Most important challenges affecting adequate translation of these frameworks into concrete policy and intervention are 1) overcoming the inclination to conceptualize SDH as mere barriers to health behavior to be modified by lifestyle interventions by addressing them as structural factors instead; 2) obtaining sufficient in-depth insight in and evidence for the exact nature of the relationship between SDs and health; 3) to adequately translate the general determinants and pathways into explanations for ill health and limited access to health care in local settings; 4) to develop and implement policies and other interventions that are adjusted to those local circumstances. We conclude that to transform generic SDH models into useful policy tools and to prevent them to transform in SDH themselves, in depth understanding of the unique interplay between local, national and global SDH in a local setting, gathered by ethnographic research, is needed to be able to address structural SD in the local setting and decrease health inequity.
authors.affiliation: Department of Health Ethics and Society, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; a.krumeich@maastrichtuniversity.nl.
authors.forename: Anja
authors.initials: A
authors.lastname: Krumeich
authors.affiliation: Department of Health Ethics and Society, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: Meershoek
mesh_terms: D022126:Access to Information; D014943:Global Health; D015438:Health Behavior; D006291:Health Policy; D006801:Humans; D008962:Models, Theoretical; D064890:Social Determinants of Health
keywords: evidence for policy; evidence for practice; globalization; health disparities; health equity; health promotion guidelines; local adaptation; local context; social determinants of health