One of the most appropriate ways to address issues regarding Medicine is to carry out an analysis of health problems through the approach of social and economic determinants of health. A study proposed by the Pontificia Universidad Javeriana established that despite the theoretical advances and the evidence collected on the influence of the social structure on people’s health status, it is still a field of study under construction that has not yet been sufficiently delimited. In this article, transcendent concepts will be addressed to understand the social determinants of health
What are the social determinants of health??
Social determinants of health (SDOH) have been defined by the World Health Organization as the situations according to which people are born, develop, work, live and age. Even the broadest set of forces and systems that influence the circumstances of everyday life is taken into account. These forces and systems may have to do with economic policies and systems, development programs, social norms and policies, and political systems. These conditions can vary significantly between subgroups of a population and this will undoubtedly affect differentiation in health outcomes. It may be inevitable that some of these conditions are differentiated, in which case they are considered inequalities. Also, the differences may be unnecessary and avoidable, in that case, they are considered inequities and, therefore, appropriate goals for policies designed to increase equity.
The SDOH are fundamental conceptual and theoretical basis in public health since its origins. Public health, in the course of its construction and consolidation process as a modern discipline, has developed different conceptions and methodologies to analyze and understand the SDOH. The Public Health Agency of Canada has identified 12 determinants of health: income and social status, social support networks, education and literacy, employment and working conditions, social environments, physical environments, personal health practices, and coping skills, develop healthy children, biology and genetic endowment, health services, gender, and culture. The social determinants of health added to the current global circumstances that we face due to the pandemic have exacerbated inequality and have disproportionately affected the poorest and most vulnerable, particularly women and children.
Advances or setbacks?
Leadership in Latin America has been assumed by the Pan American Health Organization (PAHO). In its 2008-2012 plan of action, they defined the social and economic determinants of health as one of the strategic objectives to address through policies and programs that improve health equity. According to the Pan American Health Organization, there have been improvements in access and universal coverage to health throughout the region due to factors such as advances in the economic and social development of the countries, the consolidation of some democratic processes, and strengthening of health systems in some populations. However, much remains to be done and there is a clear need to continue making collective efforts to overcome exclusion, inequity, and obstacles to access quality health services. Also, better action is needed to influence policies, plans, legislation, and regulations that address the social determinants of health. In short, we need to be inclusive, collaborative, proactive as we move forward in using an approach focused on social determinants of health to reduce inequities among populations.
It is essential to understand that the national health system of each country conditions accesses to services and programs for different social groups, that is, it affects the social determinants of health. The SDOH behave differently and they have distinct effects in each country. In this sense, studying the social determinants of health allows us to understand factually how the structure of our society is unequal. An example of a situation is the issue of vaccination worldwide since vaccines have been distributed unevenly, prioritizing people because of their political status and benefitting privileged groups leaving aside the vulnerable population. The shameful cases and scandals about the issue of vaccination have been replicated in different countries. There are several countries where officials and elites have misused their privileges. There are the cases known as “VIP vaccines” in Argentina and Ecuador, “Courtesy vaccines” in Peru, “Vacunajetas” in Spain, among others. While people who really belonged to the vulnerable population have run out of vaccines, politicians have not hesitated to make excuses and avoid responsibility for the mistakes.
The pandemic has hit the world hard, and inequalities have deepened. Today, more than a year has already passed since the first known case of COVID-19. Nevertheless, globally life losses, inequalities, fear, and uncertainty have not yet stopped. As stated by António Guterres, Secretary-General of the United Nations: “Those who were behind are being left even further behind.” To build a better future after the COVID-19 crisis and firmly retake the SDG´S, simply going back to what we used to be will not be enough. In this sense, this pandemic represents an opportunity to do things differently. The barriers that limit the development of minorities and vulnerable populations must be destroyed. Health is one of the most important bases of society, therefore, it is essential to fight for a high-quality health system and fair and egalitarian social determinants of health.
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