Saturday, September 19, 2009

The social determinants of health

I went to a talk at the Centers for Disease Control about the social determinants of health and the need to strengthen the evidence-base in order to address these issues. The speaker, from the Cochrane Group, emphasized the need to move away from simply describing/summarizing the social inequities and to begin intervening and taking action.

They discussed the World Health Organization (WHO) Commission on the Social Determinants of Health (2008) three recommendations:

1) Improve daily living conditions.
2) Tackle the inequitable distribution of power, money, and resources.
3) Measure and understand the problem and asses the impact of action.

Previously, recommendations such as these came from "expert committees" where the evidence was not always clear. Now, WHO is pushing for more real evidence in their guidelines.

Some interesting issues came up with regard this push towards evidence and "evidence-based medicine."
  • If you do studies, yes you will find evidence... but funding is what controls the kinds of studies that are done. If there is no funding to look at certain issues, how will there ever be any evidence?
  • Are under-served communities equitably represented in these studies?
  • The scientific evidence and numbers are not always congruent with, or representative of, what is happening on the ground. Can qualitative analyses adequately capture issues of social injustice and social inequities?
The speaker then listed the areas where the Cochrane Group is doing systematic reviews and making policy recommendations: income distribution, education, public safety, housing, employment, social networks, food supply, natural environment, transport, health systems.

All important, but what about diet? exercise? preventive health measures? Their challenge is that the evidence does not exist for them to conduct their systematic reviews. So, they end up doing "empty reviews," which in themselves are a powerful indicator of the areas that need more attention and funding.

To me, all of this is even more reason to study lifestyle interventions and preventive health, especially in underserved populations.

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