The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints (original) (raw)
Related papers
2016
Recently a number of calls have been made to mobilise the arsenal of political science insights to investigate – and point to improvements in – the social determinants of health (SDH), and health equity. Recently, in this journal, such a rallying appeal was made for the field of public administration. This commentary argues that, although scholarly potential should justifiably be redirected to resolve these critical issues for humanity, a key ingredient in taking action may have been neglected. This factor is ‘community.’ Community health has been a standard element of the public health and health promotion, even political, repertoire for decades now. But this commentary claims that communities are insufficiently charged, equipped or appreciated to play the role that scholarship attributes (or occasionally avoids to identify) to them. Community is too important to not fully engage and understand. Rhetorical tools and inquiries can support their quintessential role.
NEJM Catalyst, 2022
The Covid-19 pandemic exposed and intensified health inequities that caused disproportionately higher rates of infection,morbidity, and mortality inmarginalized and disadvantaged communities, along with greater social and economic devastation. At the same time, highly visible violence against Black people, includingmultiple killings by police, highlighted race and racismas a pivotal social determinant of health (SDOH). The authors describe the response of a community health center that serves a largely Latinx population. Brookside Community Health Center adapted and redesigned health care to better address SDOH, reaching beyond the traditional social determinants to address underlying factors, the drivers of those SDOH: fortifying social networks and social cohesion, political power, political voice, and protest. Brookside CommunityHealth Center’swork exemplifies the historicmission of community health centers, which defines health in the broadest of terms and recognizes the connections among health, human rights, and political power and participation.
The Journal of Primary Prevention, 2014
Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.
International Journal of Environmental Research and Public Health
This paper aims to identify challenges and opportunities related to the integration of social determinants of health (SDH) into primary healthcare at an international symposium in Orford, Quebec, Canada. A descriptive qualitative approach was conducted. Three focus groups on different topics were led by international facilitators. Two research team members took notes during the focus groups. All the material was analyzed using a thematic analysis according to an inductive method. Many challenges were identified, leading to the identification of potential opportunities: integrate the concept of SDH in all phases of the training curriculum for health professionals to foster interprofessional and intersectoral collaboration and sociocultural skills; organize healthcare for better outreach to vulnerable populations; organize local and regional committees to develop management frameworks to produce and use territory-specific data; develop dashboards for primary healthcare providers descr...
Despite what experts know about the importance of social determinants of health (SDOH), poor health is generally understood by the public as an individual problem ameliorated through lifestyle and/or healthcare. To remedy this knowledge gap and promote policy change, public health professionals are investing in media advocacy to raise public awareness about SDOH and promote collective responsibility for health improvement. However, policy theory suggests this may be insufficient. More attention to the role of professional communities, as mediators of research translation and important policy actors, is warranted. We conducted a content analysis of news articles published by the American Public Health Association and found substantial attention to SDOH. However, the discourse was more biomedical than expected given the evidence regarding the relative importance of the major categories of health determinants. This may be a barrier to policy change and detract from the field’s efforts to promote political action.
A sociological analysis of an area-based health initiative : a vehicle for social change?
2012
This thesis explores the implementation of an area-based health improvement initiative in the north west of England called Target Wellbeing. In the decades before Target Wellbeing was commissioned in 2007, health inequalities between people living in different areas of the UK had been widening. ABIs were identified by the Labour Government as a key tool for improving the health and wellbeing of residents in areas of socioeconomic disadvantage and addressing inequalities in health. ABIs such as this have been well evaluated but there remains no firm evidence about the ability of such initiatives to improve health or to reduce health inequalities. In addition to the problems associated with evaluation, the processes through which ABIs might be used to influence change are not well understood and the value of using area-based services to improve health has been taken for granted. There is little understanding about the processes through which service provider partnerships might develop and limited knowledge about the processes through which residents might develop relations with providers. The key aim of this research was to examine the social processes through which ABIs develop over time. Using a case study approach, the research examined one Target Wellbeing programme as a social figuration of interdependent people. Ethnographic methods, including documentary analysis, non-participant observation and interviews, were used to explore the processes and networks that mediated the planned public health development. The study also drew on relevant quantitative data to describe changes over time. Ideas from figurational sociology were used as sensitising concepts in the development of a substantive theory about the processes through which ABIs develop. The study developed theoretical insight into processes of joint working that helps to explain why, in the context in which services are commissioned and performance managed, provider coordination is unlikely to be implemented as planned. It also provided a more sociologically adequate account of the ways in which relations between residents and providers were influenced by the history of relations in the town. Changes to residents' relations with other residents and providers in the town influenced a greater sense of control over their circumstances. These findings demonstrate that, in relation to public health policy and practice, ABIs might more usefully be conceptualised as a series of interrelated processes that might be used to establish the preconditions for influencing change among residents. However, the study showed that interventions targeted at a small part of much wider networks of interconnected people are unlikely to influence sustained changes for residents in deprived areas.
BMC Health Services Research, 2013
Background: Commitments to community participation are common in health policy, yet ways to maximise the input and impact of community representatives in health service delivery and care remain elusive, lack empirical evidence and are under-theorised. Methods: The role of Community Participation (CP) Coordinators involved in an Australian health service were examined in a triangulated multi-method, multi-site ethnographically informed three year study. Formal fieldwork involved observation of just over 42 hours of meetings together with informal interactions in the field with staff and community members and in-depth interviews and discussions with 10 Community Representatives, 19 staff and the seven CP Coordinators employed during the study period. Results: Four key roles that Community Participation Coordinators undertake to support and facilitate the action of community representatives operating within a health service were identified in our analysis: 1) Building skills and confidence; 2) Engaging them in agendas for action: 3) Helping them navigate and understand the health system; and 4) Advocating to staff. A fifth role of advocating externally to outside groups and building coalitions is suggested as important, but was not strongly represented in our data. Conclusions: This study offers a new model synthesising the key roles of coordinating and facilitating community participation in health services which may be transferable to other health service settings. Our findings call attention to the need for health services to employ a facilitator who can support, engage, navigate and advocate for community representative's participation and influence in health service policy and practice. Background Prior to having a [Community Participation Coordinator] you wouldn't get the chance to break out like we're doing now and bring so many things in. (Community Representative, Interview)