Revisiting the social determinants of health agenda from the global South

Abstract

Abstract Background One of the most marked characteristics of the global social structure is the existence of substantial social inequalities in wealth, which also find expression in health inequalities between and within countries. In an effort to provide an overview of the conceptual debates shaping the mobilisation around social determinants of health and health inequities, two of the most influential approaches in the field are compared: the WHO Commission on Social Determinants of Health approach (CSDH), strongly influenced by European Social Medicine, and the Latin American Social Medicine and Collective Health (LASM-CH) Social determination of the health-disease process approach, hitherto largely invisibilized. Methods A comprehensive literature review was conducted in three databases (Lilacs, Scielo, Medline/Pubmed), reference lists of selected papers, and citations in Google Scholar, including book titles. Results It is argued that the debates shaping the SDH agenda do not merely reflect terminological and conceptual differences, but essentially different ethical-political proposals that define the way health inequities are understood and proposed to be transformed. Conclusions While the health equity and SDH agenda probably also gained momentum due to the broad political alliance it managed to consolidate, it is necessary to make differences explicit as this allows for an increase in the breadth and specificity of the debate, facilitating the recognition of contextually relevant proposals towards the reduction of health inequities. Key messages Debates shaping the SDH agenda do not merely reflect terminological or conceptual differences, but distinct ethical-political proposals. Differences need to be discussed and made explicit to guide the development of contextually relevant efforts to reduce health inequities.