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Putting the ‘Social’ Back in: Social Determinants of Health as a Methodological Lens

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Abstract

The messages of the SDH Commission report are not necessarily novel but they have an additional significance in the current climate of health, which witnesses the failure of the Alma Ata declaration of achieving ‘Health for All’ with increasing evidence on persistent inequities in different parts of the world. The significance of the report also lies in the fact that it provides an apt forum for a dialogue among disciplines (roughly between social science disciplines including humanities and conventional health sciences) and different stakeholders including academics, practitioners and civil society advocacy groups. It signals the ‘coming together’ of a diverse set of actors/perspectives/methodologies that are, more importantly, liberating the study of health from a narrow lens of biomedicine in the common pursuit of striving towards health equity. The spirit of dialogue is hence critical as several concerns relating to conceptualization (the unpacking of the ‘social’) and operationalization (identifying actions on the social determinants and developing indicators for monitoring inequalities) emanate from such a conversational space among the different actors and disciplines involved. In the spirit of such a conversation, this chapter talks about what the ‘social’ in social determinants of health entails and its implications in terms of research and actions. It argues that social determinants of health needs to be seen as a methodological lens than rediscovering a new set of factors or causes leading to inequity.

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Notes

  1. 1.

    The social composition of the nine knowledge networks makes it a truly multidisciplinary exercise drawing on disciplines as well as professional backgrounds (academics, researchers, activists and practitioners). The very identification of the knowledge networks including early childhood, gender equity, health systems, social exclusion, urban settings, and employment conditions, demonstrate the inclusive understanding of health.

  2. 2.

    IDRC, Canada has begun a Closing the Gap initiative based in the Sree Chitra Tirunal Institute of Medical Science and Technology (SCTIMST), Thiruvanthapuram in order to strengthen the capacity for undertaking health equity research in India. See for details https://www.idrc.ca/en/project/closing-gaps-health-equity-research-initiative-india.

  3. 3.

    The film ‘Enough of this silence’ (2005), based on research in Koppal district, projects such actions.

References

  1. World Health Organisation Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. 2008 [cited 2016 Nov 18]; Available from: http://apps.who.int/iris/handle/10665/43943.

  2. Bhattacharya S, Messenger S, Overy C, eds. Social determinants of health: assessing theory, policy and practice. Orient Blackswan; 2010.

    Google Scholar 

  3. Hunt P. Missed opportunities: human rights and the commission on social determinants of health. Glob Health Promot. 2009;16(1 suppl):36–41.

    Article  Google Scholar 

  4. Navarro V. What we mean by social determinants of health. Int J Health Serv. 2009;39(3):423–41.

    Article  PubMed  Google Scholar 

  5. Schofield T. Health inequity and its social determinants: a sociological commentary. Health Sociol Rev. 2007;16(2):105–14.

    Article  Google Scholar 

  6. Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, et al. The commission on social determinants of health: tackling the social roots of health inequities. PLoS Med. 2006;3(6):e106.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gwatkin DR, Ergo A. Universal health coverage: friend or foe of health equity? Lancet. 2011;377(9784):2160–1.

    Article  PubMed  Google Scholar 

  8. Latko B, Temporão JG, Frenk J, Evans TG, Chen LC, Pablos-Mendez A, et al. The growing movement for universal health coverage. Lancet. 2011;377(9784):2161–3.

    Article  PubMed  Google Scholar 

  9. Mishra A, Rao SS. Unpacking the discourse on universal health coverage in India. Soc Med. 2016;9(2):86–92.

    Google Scholar 

  10. Marmot M. Universal health coverage and social determinants of health. Lancet. 2013;382(9900):1227–8.

    Article  PubMed  Google Scholar 

  11. Sengupta A, Prasad V. Developing a truly universal Indian health system: the problem of replacing “health for all’ with “universal access to health care”. Soc Med. 2011;6(2):69–72.

    Google Scholar 

  12. Narayan R, Narayan T. Universal health coverage for India. BMJ. 2012;344:e2247.

    Article  PubMed  Google Scholar 

  13. Bastos C. The social determinants of health and the hierarchies of knowledge. Soc Determinants Health Assess Policy Theor Pract. 2010;263–271.

    Google Scholar 

  14. McKeown T. The modern rise of population. London: Edward Arnold; 1976.

    Google Scholar 

  15. Illich I. Medical nemesis. New York: Pantheon. 1976;30:41.

    Google Scholar 

  16. Marmot MG, Rose G, Shipley M, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health. 1978;32(4):244–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Marmot MG, Shipley MJ, Rose G. Inequalities in death—specific explanations of a general pattern? Lancet. 1984;323(8384):1003–6.

    Article  Google Scholar 

  18. Marmot MG, Stansfeld S, Patel C, North F, Head J, White I, et al. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337(8754):1387–93.

    Article  CAS  PubMed  Google Scholar 

  19. Court SD. Inequalities in health. Report of a research working group. Arch Dis Child. 1981;56(3):161.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Farmer P. Infections and inequalities: the modern plagues. University of California Press; 2001.

    Google Scholar 

  21. Farmer PE, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical medicine. PLoS Med. 2006;3(10):e449.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Parker M, Harper I. The anthropology of public health. J Biosoc Sci. 2006;38(01):1–5.

    Article  PubMed  Google Scholar 

  23. Narayan T. A violation of citizens’ rights: the health sector and tuberculosis. Issues Med Ethics. 1999;7:3.

    Google Scholar 

  24. Das V, Das RK. Urban health and pharmaceutical consumption in Delhi, India. J Biosoc Sci. 2006;38(1):69.

    Article  PubMed  Google Scholar 

  25. George A. Persistence of high maternal mortality in Koppal district, Karnataka, India: observed service delivery constraints. Reprod Health Matters. 2007;15(30):91–102.

    Article  PubMed  Google Scholar 

  26. Greenough P. Introduction. Soc Sci Med. 1995;41(5):605–7.

    Article  CAS  PubMed  Google Scholar 

  27. Mishra A, Flikke R, Nordfeldt C, Nyirenda L. Immunization is good for your children’: local immunization practices in India and Malawi. Prot Worlds’ Child Immun Policies Pract. 2013;149–186.

    Google Scholar 

  28. Mishra A. “Trust and teamwork matter”: community health workers’ experiences in integrated service delivery in India. Glob Public Health. 2014;9(8):960–74.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nichter M. Vaccinations in the Third World: a consideration of community demand. Soc Sci Med. 1995;41(5):617–32.

    Article  CAS  PubMed  Google Scholar 

  30. Ross CE, Wu C-L. The links between education and health. Am Sociol Rev. 1995;60(5):719–45.

    Article  Google Scholar 

  31. Dahl E. Social inequalities in ill-health: the significance of occupational status, education and income-results from a Norwegian survey. Sociol Health Illn. 1994;16(5):644–67.

    Article  Google Scholar 

  32. Dey DK, Mishra V. Determinants of choice of health care services utilization: empirical evidence from India. Indian J Community Health. 2014 Dec 15;26(4):356–63.

    Google Scholar 

  33. Mehta S, Parmar GB, Gamit CL, Mansuri BM, Patel PB, Patel SS. Does maternal education affect maternal and child health care utilization? A community based study in a urban slum area of western India. 2014. [cited 2016 Nov 18]; Available from: http://imsear.li.mahidol.ac.th/handle/123456789/176207.

  34. Govindasamy P, Ramesh BM. Maternal education and the utilization of maternal and child health services in India. 1997. [cited 2016 Nov 18]; Available from: http://scholarspace.manoa.hawaii.edu/handle/10125/3472.

  35. Choudhury PK. Explaining the role of parental education in the regional variations in infant mortality in India. Asia Pac Policy Stud. 2015;2(3):544–72.

    Article  Google Scholar 

  36. Saikia, N, Kulkarni P. Data for research into health inequalities in India: Do we have enough? Econ Polit Wkly. 2016;(11):26 & 27.

    Google Scholar 

  37. Östlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L, Hertzman C, et al. Priorities for research on equity and health: towards an equity-focused health research agenda. PLoS Med. 2011;8(11):e1001115.

    Article  PubMed  PubMed Central  Google Scholar 

  38. McGibbon E, McPherson C. Applying intersectionality & complexity theory to address the social determinants of women’s health. 2011. [cited 2016 Nov 18]; Available from: https://tspace.library.utoronto.ca/handle/1807/27217.

  39. Sen G, Iyer A, Mukherjee C. A methodology to analyse the intersections of social inequalities in health. J Hum Dev Capab. 2009;10(3):397–415.

    Article  Google Scholar 

  40. Samuelsen H, Tersbøl BP, Mbuyita SS. Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania. BMC Health Serv Res. 2013;13(1):1.

    Article  Google Scholar 

  41. Sébastia B. The last resort: Why patients with severe mental disorders go to therapeutic shrines in India. Restoring Ment Health India Pluralistic Ther Concepts. 2009;184–209.

    Google Scholar 

  42. Roodt D. Yesterday, Film (Language English and Julu). HBO Films: USA; 2004.

    Google Scholar 

  43. Sen G, Iyer A, George A. Systematic hierarchies and systemic failures: Gender and health inequities in Koppal District. Econ Polit Wkly. 2007;682–90.

    Google Scholar 

  44. Jeffery P, Jeffery R. Only when the boat has started sinking: a maternal death in rural north India. Soc Sci Med. 2010;71(10):1711–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Holmes SM. An ethnographic study of the social context of migrant health in the United States. PLoS Med. 2006;3(10):e448.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Chard SE. Routes to government TB treatment. Med Anthropol Q. 2009;23(3):257–76.

    Article  PubMed  Google Scholar 

  47. Roalkvam S, McNeill D, Blume S. Protecting the world’s children: immunisation policies and practices [Internet]. OUP Oxford; 2013.

    Google Scholar 

  48. Mishra A. Anthropology and public health. Indian Anthropol. 2013;(special issue):42.

    Google Scholar 

  49. McNeill, D, Andersen, S, Sandberg, K. The global politics of health: actors and initiatives. In Roalkvam S, Mcneill D, Blume S, editors. Protecting the world's children: Immunization policies and practices. Oxford University Press.

    Google Scholar 

  50. Papp SA, Gogoi A, Campbell C. Improving maternal health through social accountability: a case study from Orissa. India. Glob Public Health. 2013;8(4):449–64.

    Article  PubMed  Google Scholar 

  51. Sheikh K, Porter JD. Disempowered doctors? A relational view of public health policy implementation in urban India. Health Policy Plan. 2010;26:83–92.

    Google Scholar 

  52. Erasmus E, Gilson L. How to start thinking about investigating power in the organizational settings of policy implementation. Health Policy Plan. 2008;23(5):361–8.

    Article  PubMed  Google Scholar 

  53. Bhatia M, Rifkin S. A renewed focus on primary health care: revitalize or reframe? Globalisation and Health. 2010;6(13).

    Google Scholar 

  54. Wong ST, Browne AJ, Varcoe C, Lavoie J, Smye V, Godwin O, et al. Enhancing measurement of primary health care indicators using an equity lens: an ethnographic study. Int J Equity Health. 2011;10(1):1.

    Article  Google Scholar 

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Authors and Affiliations

  1. Azim Premji University, Bangalore, India

    Arima Mishra

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  1. Arima Mishra
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Correspondence to Arima Mishra .

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  1. The George Institute for Global Health, New Delhi, Delhi, India

    Devaki Nambiar

  2. WASH in Health and Nutritions, WASH in Schools, WaterAid India, New Delhi, Delhi, India

    Arundati Muralidharan

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Mishra, A. (2017). Putting the ‘Social’ Back in: Social Determinants of Health as a Methodological Lens. In: Nambiar, D., Muralidharan, A. (eds) The Social Determinants of Health in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-5999-5_2

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  • DOI: https://doi.org/10.1007/978-981-10-5999-5_2

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