Abstract
This paper examines the recommendations of the World Health Organization's Commission on the Social Determinants of Health regarding the need for improved research on determinants of health inequity and discusses the following barriers to implementation of those recommendations: the power of the biomedical imagination in health and medical research; emphasis on vertical health programming; ideological biases outweighing evidence in policy decisions; and academic reward systems, including the inherent conservatism of peer review. The paper concludes with suggestions for changing research funding and assessment systems to overcome these barriers.
Highlights
The World Health Organization’s Commission on the Social Determinants of Health in its final report called for a greater focus on research on the social determinants of health and health inequities.[1]
This paper identifies and discusses four such barriers: 1) the power of the biomedical imagination in health and medical research, 2) the dominant focus on vertical health programming, 3) the influence of ideological biases outweighing evidence in policy decisions, 4) academic reward systems that encourage simple research designs on proximal causes of disease, and the inherent conservatism of peer review systems
Health care systems in most countries are dominated by a Western biomedical understanding of health and disease, which has a strong basis in individualism.[2,3,4]. This approach has been used to good effect for clinical treatment of individuals but tends to obscure the value to population health of social and economic interventions acting on the social determinants of health
Summary
This paper examines the recommendations of the World Health Organization’s Commission on the Social Determinants of Health regarding the need for improved research on determinants of health inequity and discusses the following barriers to implementation of those recommendations: the power of the biomedical imagination in health and medical research; emphasis on vertical health programming; ideological biases outweighing evidence in policy decisions; and academic reward systems, including the inherent conservatism of peer review.
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