Social Determinants of Health and Political Responsibility

Earlier this month I wrote a guest post over at the Inequalities Blog. The piece remarked on the growing attention being given to issues of health equity and broader determinants of health in the US. I questioned however, whether this trend is worth celebrating, given its apolitical nature.

An upcoming article in the Annual Review of Public Health similarly highlights that increasing attention is being directed towards the social determinants of health (SDOH) in the US. Authors of the article praise the trend as the SDOH field's ‘coming of age'.

While the authors of the piece acknowledge political will as a significant barrier to action on the social determinants of health, the impacts of neighborhood conditions, working conditions, education, income, racism and stress (defined as upstream determinants of health) are scantily identified as a consequence of the even more upstream determinants of health: politics.

Therefore, as you might guess, I am wary of the authors' commendation I also find it particularly ironic. This is because a ‘coming of age' is typically associated with a substantial undertaking of political responsibility, granted to individuals in late adolescence via the right to vote.

By recognizing that health lies outside the medical system, US public health professionals acknowledge that health should no longer be defined as the responsibility of doctors. By accepting that health is amenable to political interventions, they should therefore also accept that its promotion becomes the responsibility of political actors. SDOH efforts in the US however, in failing to direct attention to the fundamental political determinants of health, have yet to fully undertake this political responsibility, and I would argue have thus failed to ‘come of age'.

But this of course relies on the assumption that public health professionals are, and should be, political actors.

What do others make of this?

Crossposted from HealthyPolicies