Getting social: Public Health's increasing awareness of the social determinants of health

摘要

Even though the media and industry continue to tell us that lifestyle choices are both a threat to and the salvation of our health, there is a growing consensus in Public Health research that health and longevity are substantially determined by non-medical and non-behavioural factors (Raphael 2006, Richter & Hurrelmann 2009). Most of today's health problems can be traced back to the social conditions in which we live and work. The report of the WHO Commission on Social Determinants of Health is a new milestone in documenting this shift in perspectives (CSDH 2008). Accordingly, health and health inequalities are increasingly understood as the result of an interdependent process of contextual conditions (such as governance and policy), socioeconomic position, health care systems and life circumstances (Starfield 2007). These social determinants influence a broad set of an individual's resources as well as biological, psychological and behavioural reactions that further shape health. Each of these factors contributes to the explanation of health and illness, and constitutes a complex dialogue between structure and agency that is increasingly being rewritten by Public Health research. The contributions in the current issue of the Journal of Public Health exemplify the increasing awareness of Public Health researchers by focussing on welfare state regimes, social inequalities, psychosocial resources and various aspects of health care.