Pförtner, Timo-Kolja

Richter, Matthias

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EDITORIALGetting social: Public Health’s increasing awarenessof the social determinants of healthTimo-Kolja Pförtner & Matthias RichterPublished online: 11 January 2011# Springer-Verlag 2011Even though the media and industry continue to tell us thatlifestyle choices are both a threat to and the salvation of ourhealth, there is a growing consensus in Public Health researchthat health and longevity are substantially determined by non-medical and non-behavioural factors (Raphael 2006, Richter& Hurrelmann 2009). Most of today's health problems canbe traced back to the social conditions in which we live andwork. The report of the WHO Commission on SocialDeterminants of Health is a new milestone in documentingthis shift in perspectives (CSDH 2008). Accordingly, healthand health inequalities are increasingly understood as theresult 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 anindividual’s resources as well as biological, psychologicaland behavioural reactions that further shape health. Each ofthese factors contributes to the explanation of health andillness, and constitutes a complex dialogue between structureand agency that is increasingly being rewritten by PublicHealth research. The contributions in the current issue of theJournal of Public Health exemplify the increasing awarenessof Public Health researchers by focussing on welfare stateregimes, social inequalities, psychosocial resources andvarious aspects of health care.Several papers in this issue deal explicitly with the widerdeterminants of health: The first article from Hurrelmann etal. takes a broad perspective and introduces an analysis ofthe impact of different welfare state regimes on populationhealth and health inequalities. The authors present anencompassing overview of the existing social policy andpublic health literature, and provide a framework thatoutlines potential pathways linking welfare policy, livingconditions and population health. The proposed theoreticalapproach on the association between welfare state regimesund health facilitates the understanding of health inequal-ities within and between countries. Using a macro-levelapproach, Chan analyses the impact of demographicchange, economic conditions and health care supply oninfant mortality in Singapore. He shows that the level ofinfant mortally is directly reduced by health care provision,which, in turn, is affected by the level of economic hardship(income per capita and inflation rate) and demographicchanges (marriage level, female education level, birth rate).Stroebele et al. take a closer look at contextual conditionsof individual health by assessing variety and pricing ofselected foods in different socioeconomic districts in Berlin,Germany. Interestingly, when directly comparing thenumber of grocery stores, the variety of fresh fruits andvegetables being offered, and food prices in low vs. highsocioeconomic districts, the authors found no differencesthat would account for health inequalities. Baiden et al.study the association between satisfaction with housing andthe ability to cope with daily demands in Accara, Ghana.Their findings indicate that satisfaction with housing islower among higher age groups, crowded and compoundhouseholds, and less educated people. Taking these andother indicators of housing and socioeconomic conditionsinto account, the ability to cope with daily demands issignificantly reduced for people who are dissatisfied withT.-K. PförtnerSOCLIFE Research and Training Group, University of Cologne,Cologne, GermanyM. Richter (*)Institute of Social and Preventive Medicine, University of Bern,Niesenweg 6,3012 Bern, Switzerlande-mail: mrichter@ispm.unibe.chJ Public Health (2011) 19:1–2DOI 10.1007/s10389-010-0392-0their housing conditions. Rostila et al. examine theorganisational climate and culture within the Finnish publichealth and social services, and emphasise the variousaspects of contextual differences. Based on a differentiationbetween working units and upper organisational levels, theyconclude that there are different forms of organisationalclimate and culture within Finnish public human serviceorganisations that have emerged by different mechanisms inthese levels.Two studies focus on more proximate determinants ofhealth, such as individual conditions, resources andbehaviour. In their analysis Gao and Chen analyse theassociation between different aspects of social support andsexually transmitted infections in Canada. After adjustmentfor health behaviours, socioeconomic conditions andmarital status, a consistent negative association betweendifferent types of social support and risks of sexuallytransmitted infections in women aged 15–24 years wasfound. Although these results could not be replicated forolder women and men, the study underlines the importanceof social support for sexually transmitted infections inyoung women. In a second study, Draxler et al. reportfindings on the relationship between practising Asianmartial arts and health-related quality of life in Germany.Based on three samples composed of a reference group andtwo different samples of people practicing martial arts, theauthors find significant differences between martial artistsand the general population for all physical and somepsychological elements of the SF-36 questionnaire.The remaining studies in the current issue shed light ondifferent dimensions of health care services. Hasseler et al.present results from patient-oriented interviews on barriersto and resources for effective diabetes care management inGermany. The patients' views on possible coping strategies,healthy lifestyle resources and barriers hampering theadoption of healthy behaviours lead the authors to concludethat support for people with type 2 diabetes in primary careand home settings is needed. The study from Piso et al.presents findings from two DELPHI discussions on theintroduction and funding of vaccines. Based on interviewswith international immunisation experts they propose astructured, comprehensive and transparent framework fordecision-making in vaccine introduction that will strengthenvaccination as an effective public health tool. Chong et al.evaluate the level of patients’ and physicians’ acceptance ofgeneric medicines and assess the achieved cost savings fromsubstituting these for brand name medicine requests inMalaysia. Their results indicate that generic medicine ishighly accepted among physicians and patients, and that apositive substitution contributes significantly to a reduction ofexpenditures on medicines. Finally, the study from Manovaet al. examines the influence of generic and/or therapeuticcompetition on market share and prices of cardiovascularmedicines in Bulgaria. The introduction of generic productsfor cardiovascular medicines is accompanied by changes inmarkets and a delayed price reduction. In line with Chonget al., the authors emphasise the implementation of genericsubstitution policies to control the demand for and dispensingof generic medicines.Together, these studies provide important additionalinsight into the social determinants of health andunderline the increasing awareness of the social dimensionin Public Health. As these studies must be considered afirst step in future prospects of Public Health research,further efforts are strongly needed to close the social gapin Public Health.ReferencesCommission on Social Determinants of Health (2008) Closing theGap in a Generation: Health equity through action on the socialdeterminants of health. Final Report of the Commission on SocialDeterminants of Health. World Health Organization, GenevaRaphael D (2006) Social Determinants of Health: An Overview ofConcepts and Issues. In: Raphael D, Bryant T, Rioux M (eds)Staying Alive. Critical Perspectives on Health, Illness, andHealth Care. Canadian Scholars’ Press, Toronto, pp 115–138Richter M, Hurrelmann K (2009) Gesundheitliche Ungleichheit. Grund-lagen, Probleme, Perspektiven [Social inequalities in health:principles, problems, perspectives. 2nd Edition]. Wiesbaden: VSVerlag für SozialwissenschaftenStarfield B (2007) Pathways of influence on equity in health. Soc SciMed 64(7):1355–13622 J Public Health (2011) 19:1–2

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

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

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