In an invited commentary to the International Journal of Health Services, Professor Dennis Raphael of York University together with Ontario Tech University Associate Professor Toba Bryant outlined seven emerging themes in social determinants of health theory and research.
These themes go beyond traditional notions that carrying out high-quality research and presenting them to policymakers will lead to health-promoting public policy. Instead, the authors identify significant barriers to having this research put into practice by governmental authorities increasingly under the sway of corporate and business influence. The corporate and business sector commonly calls for reduced government spending, lack of regulation of the workplace, and reduced taxes on the corporate and business sector, positions at odds with the findings of this research.
The seven themes are:
- Models of Public Policy Change (traditional models of public policy change do not represent how public policies actually come about);
- The Political Economy of Health (public policy is increasingly under the sway of political and economic interests whose desires are not aligned with the needs of most Canadians);
- Unionization and Collective Agreement Bargaining (these processes are key to promoting health but neglected in health promotion research and action);
- Corporate Domination of the Base and Superstructure of Society (it is increasingly apparent that the corporate and business sector are shaping both economic and political processes as well as all aspects of civil society);
- Neoliberalism, Redistribution and Service Delivery (increasing acceptance of neoliberal approaches to governance are leading to greater inequities in the distribution of resources necessary for health as well as degrading of health and social services);
- Communication and Polemic (it is necessary to raise the volume on these issues as traditional communication approaches are not working); and
- Social Welfare States or Socialist States (it is becoming apparent that many of the barriers to having the social determinants of health addressed are rooted in Canada's form of capitalism. The environmental crisis is leading to questioning whether a climate catastrophe can be avoided under our present economic system.)
In the conclusion of their commentary, Raphael and Bryant state: "The apparent inability of government authorities to control the power and influence of the corporate sector is yet another reason for a reconsideration of the current economic system and whether capitalism is capable of maintaining, much less improving, the quality and equitable distribution of the social determinants of health."
Finally, Raphael points out that most of the work cited in the paper was conducted with graduate students in York University's Graduate Program in Health Policy and Equity. The paper "Emerging Themes in Social Determinants of Health Theory and Research" is available at https://journals.sagepub.com/doi/10.1177/00207314221109515.