Abstract
The social justice framing within the WHO Commission’s Report on the Social Determinants of Health is vital. Yet it can too easily be dismissed as ideology and an unfit justification for major change. Although the general public acknowledges that structural factors, such as poverty, can affect health, they tend to see personal health behaviours as the strongest determinants of health, mirroring the main focus of health providers in recent decades. Thus a social reform agenda, while being an integral part of public health history, is nowadays too often seen as remote from the essential core of work in health. Translating the Commission’s agenda into action therefore requires a recalibration of our entire health system, starting with an understanding of how complex issues can be framed in ways that inspire action, endorse mutuality of interests and enhance the perceived efficacy of the solutions, among the myriad of actors in position to make the reduction of health inequities succeed or fail. A sophisticated discourse analysis and/or communications research agenda could help to move us forward. It involves understanding and reframing the way politicians, policy-makers, practitioners and the public see “the problem” and reframing the potential of many roles in “the solution”.
Keywords: Social determinants of health, discourse analysis, media, communication, values
Résumé
Le cadre de justice sociale du Rapport sur les déterminants sociaux de la Commission de l’OMS est vital. Pourtant, il peut facilement être écarté en tant qu’idéologie et justification inappropriée pour un changement d’envergure. Même si le grand public reconnaît que les facteurs structurels, comme la pauvreté, peuvent avoir des répercussions sur la santé, il a tendance à percevoir les comportements personnels en matière de santé comme les déterminants les plus forts de la santé, reflétant le point de mire des fournisseurs de soins de santé des dernières décennies. Ainsi, un programme de réforme sociale, même s’il fait partie intégrante de l’histoire de la santé publique est, de nos jours, trop souvent perçu comme étant trop loin de l’essence du travail en santé. La traduction du programme de la Commission en des mesures concrètes exige ainsi un réétalonnage de l’ensemble de notre système de santé, en commençant par une compréhension de la façon dont les questions complexes peuvent être encadrées de sorte qu’elles inspirent l’action, par l’appui de la mutualité des intérêts et par l’amélioration de l’efficacité perçue des solutions, parmi une myriade d’acteurs, afin que la réduction des inégalités en santé réussisse ou échoue. Un programme haut de gamme de recherche en matière de communications ou d’analyse du discours pourrait contribuer à l’accomplissement de progrès à cet égard. Il exige la compréhension et le recadrage de la manière dont les politiciens, les décideurs, les praticiens et le public perçoivent «le problème» ainsi que le recadrage du potentiel de nombreux rôles dans la «solution».
Mots clés: déterminants sociaux de la santé, analyse du discours, médias, communications, valeurs
Footnotes
Acknowledgements: Dr. Hawe is the Markin Chair in Health and Society and holds a Health Scientist award from the Alberta Heritage Foundation for Medical Research. She is a member of the International Union of Health Promotion and Health Education’s Global Working Group on the social determinants of health. Thanks to Alan Shiell for comments on an earlier draft.
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