Abstract
BackgroundThe Commission on Social Determinants of Health (CSDH) identifies the maldistribution of power, money, and resources as main drivers of health inequities. The CSDH further observes that tackling these drivers effectively requires interventions to focus at local, national, and global levels. Consistent with the CSDH’s observation, this paper describes the eco-psychopolitical validity (EPV) paradigm, a multilevel and transdisciplinary model for research and action, thus far insufficiently tapped, but with the potential to systematize the exploration of the social determinants of health.ResultsUsing the physician migration from Sub-Saharan Africa (SSA) to the United States as illustration, this paper articulates how the EPV model can be applied to the systematic analysis of a complex social problem with health inequity implications. To help explore potential determinants of physician migration, a comprehensive coding matrix is developed; with the organizing metaphors of the EPV model–namely oppression, liberation, and wellbeing–serving as analytical categories. Through the lens of the EPV model, migrating physicians are revealed as both ecological subjects enmeshed in a vast web of transnational processes linking source and destination countries, and potential change agents pursuing liberation and wellbeing. While migration may expand the opportunities of émigré physicians, it is argued that, the pursuit of wellbeing by way of migration cannot fully materialize abroad without some efforts to return home, physically or socially.ConclusionClarifying the relationship between various social determinants of health and health inequities at different levels of analysis is a more complex but essential endeavor to knowledge generation than using a one-dimensional frame. With its roots in interdisciplinary thinking and its emphasis on both individual and contextual factors, the EPV paradigm holds promise as a model for examining the social determinants of health.
Highlights
The Commission on Social Determinants of Health (CSDH) identifies the maldistribution of power, money, and resources as main drivers of health inequities
The selected findings highlighted are abstracted into three main categories reflecting the three inter-related dynamics posited as determining human migration: oppression, liberation, and wellbeing
Sources of oppression Two potential research questions that could be addressed by the exploration of sources of oppression are: What are the professional and personal needs of Sub-Saharan Africa (SSA) migrant physicians? What structural and interpersonal factors are likely to intensify these needs? A close examination of Table 2 suggests that a host of factors within and beyond the Empowerment/Liberation
Summary
The Commission on Social Determinants of Health (CSDH) identifies the maldistribution of power, money, and resources as main drivers of health inequities. Juxtaposing a list of push factors in source countries and pull factors from receiving countries, as commonly found in the health policy literature, provides little insight as to how medical migration occurs and why it persists despite widespread knowledge of the inequalities of medical personnel between doctor-outsourcing but need-plagued countries and doctor-receiving nations [8]. Such binary analysis does not inform as to why some health professionals with ample opportunities to emigrate choose instead to stay in their resource-limited homelands
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