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Canadian Journal of Public Health

, Volume 104, Issue 1, pp e52–e54 | Cite as

Getting to the Root of the Problem: Health Promotion Strategies to Address the Social Determinants of Health

  • Dana M. Gore
  • Anita R. KothariEmail author
Commentary
  • 1 Downloads

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.

Key words

Chronic disease health promotion public health practice social conditions social change social environment 

Résumé

De nombreuses études montrent que les déterminants sociaux de la santé influencent la distribution et l’évolution des maladies chroniques, mais peu de programmes de santé publique abordent les déterminants sociaux comme stratégie de prévention des maladies. Nous expliquons les différents types d’initiatives de promotion de la santé et nous les différencions selon qu’elles tentent d’avoir des effets sur les déterminants intermédiaires (environnementaux) ou structurels de la santé. Nous plaidons en faveur de l’importance des programmes qui ciblent les déterminants structurels plutôt que ceux qui ciblent uniquement l’environnement immédiat. Les premiers sont en effet plus susceptibles d’apporter des améliorations significatives à la santé, de contribuer à un changement social durable et d’accroître l’équité en santé. Nous exhortons les responsables de la santé publique à tenir compte de cette distinction dans la planification des programmes de santé publique et à renforcer la capacité des effectifs de la santé publique de s’attaquer aux mécanismes structurels qui mènent aux problèmes de santé et aux iniquités en santé.

Mots clés

maladie chronique; promotion de la santé pratique en santé publique situation sociale changement social environnement social 

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Copyright information

© The Canadian Public Health Association 2012

Authors and Affiliations

  1. 1.School of Health Sciences, Faculty of Health SciencesUniversity of Western OntarioLondonCanada

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