Ten years on from the World Health Organization Commission of Social Determinants of Health: Progress or procrastination?

Australia in 2030: what is our path to health for all?

Positioning health promotion as a policy priority in Australia.

Climate change and health promotion in Australia: Navigating political, policy, advocacy and research challenges.

There has been insufficient research involving Aboriginal and Torres Strait Islander peoples living in urban areas to inform strategies required to improve inequitable health outcomes and life expectancy for Aboriginal and Torres Strait Islander peoples. The injustice of these health inequities motivated me to investigate the use of computerised Aboriginal and Torres Strait Islander health assessments in primary care as a source of research data which can be used to respond to community priorities. I conducted this research at the Inala Indigenous Health Service, a Queensland Government funded primary health care service for Aboriginal and Torres Strait Islander peoples. Inala is a suburb in south- western Brisbane with a strong sense of community and identity, but also significant social and economic challenges. Staff at the Inala Indigenous Health Service have been using Aboriginal and Torres Strait Islander health assessments for both clinical and research purposes since their introduction in 2004 for adults, and 2006 for children.In this thesis, I used a mixed methods approach. The first two research projects of this thesis are situated in the postpositivist paradigm where researchers accept that scientific research produces evidence which helps establish the probability that a finding is true rather than truth itself. The first research project evaluated the feasibility of implementing computerised health assessments in primary care for dual clinical and research purposes. After finding that it was feasible, the second research project established that computerised health assessment data were sufficiently representative, complete, reliable, and valid to produce credible research findings.The final two research projects of this thesis are situated in the transformative paradigm with the explicit goal of improving the social world. I acknowledge that my position as a white, non-Indigenous, male, medical researcher influenced the conduct and outcome of all the research projects in this inquiry. To minimise the risk that this research would reproduce the damaging effects of research for Aboriginal and Torres Strait Islander peoples conducted by non-Indigenous researchers, I listened to community voices to inform my approach to research using computerised health assessment information.I conducted a qualitative study involving thematic analysis of semi-structured interviews with key informants in the Inala Aboriginal and Torres Strait Islander community regarding their priorities for health and research based on health assessment data. Rather than a discrete set of health priorities, key informants articulated an authoritative understanding of how interrelated, inter-generational, social, cultural, and environmental determinants of health operated in a “cycle” to influence the community’s health. Furthermore, some key informants were ambivalent about Aboriginal and Torres Strait Islander health assessments because of their biomedical emphasis. These findings supported the addition of questions to health assessments at the Inala Indigenous Health Service regarding psychosocial stressors, social determinants of health, and community participation. Because of key informants’ emphasis on the social determinants, I conducted an epidemiological investigation of social, cultural, and environmental determinants of health using adult computerised health assessment data. From this investigation, I found that the experience of a range of social, cultural, and environmental determinants of health varied significantly according to the age and sex of participants suggesting opportunities for demographically targeted policy intervention.Findings from this doctoral research demonstrate that Aboriginal and Torres Strait Islander computerised health assessments can be implemented in the primary health care setting, and used to produce credible research findings which respond to community priorities. Presently, the widespread application of computerised health assessment based research has been limited by commonly used general practice software systems in Australia which include non-customisable health assessments, and are not suited to research. At the Inala Indigenous Health Service, future research based on computerised health assessments will seek to further investigate social, cultural, and environmental determinants of health, and could include longitudinal analysis and data linkage.The results of key informant interviews and the investigation of social, cultural, and environmental determinants will be fed back to community organisations and health services as a community report. This community report was designed to assist community organisations and health services plan, monitor, advocate, and apply to policy makers for funding for activities, programs, and services to address social, cultural, and environmental determinants of health.This research also revealed tensions inherent in attempting to reconcile the health priorities of community key informants situated in the social world with a medical researcher, a health service setting, and research tool, the health assessment, all situated within the privileged biomedical model of health. By positioning research in this thesis in the transformative paradigm using a mixed methods approach, I endeavoured to acknowledge and explore these tensions. These research findings encourage a policy discourse which does not emphasise the biomedical model of health, but rather emphasises the importance of taking the holistic view of health expressed by both the National Aboriginal Health Statement Working Party and Inala Aboriginal and Torres Strait Islander key informants.

Global action on social determinants of health

The need for improved Australian data on social determinants of health inequities

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

Beyond COVID-19: Consumers call for greater focus on health equity.

Social determinants of health: social justice and vested interests

Ngaaminya (find, be able to see): summary of key findings from the Which Way? project

What ngidhi yinaaru nhal yayi (this woman told me) about smoking during pregnancy.

COVID-19: Vulnerability and the power of privilege in a pandemic.

In August 2008, the Commission on Social Determinants of Health (CSDH) of the World Health Organization published its report, Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. The report integrates extensive data from a wide variety of sources on the significant role of the social determinants of health in shaping health outcomes and generating inequalities in health status within and among countries. This analysis is juxtaposed with a compelling justice ethic. The report addresses many of the same issues and expresses many of the same concerns as the health and human rights community and more broadly human right scholarship and advocacy on other economic and social rights. Nevertheless, the CSDH did not acknowledge this common ground. Nor did the report explicitly place access to the key social determinants of health in a human right framework. This article addresses the implications of the CSDH's unwillingness to acknowledge its shared ground with and to adopt at least some elements of the human rights paradigm for its report. It discusses areas of overlap and difference between a human rights paradigm and the social determinants and equity framework adopted by the CSDH. It argues that the failure to incorporate an explicit human rights approach weakened the line of reasoning in some sections of Closing the Gap in a Generation, rseduced prospects for adoption of its recommendation and diminished the likelihood of fulfilling its mandate to foster a global movement to promote health equity.

The report by the World Health Organization’s (WHO) Commission on Social Determinants of Health (CSDH) ( Closing the gap in a generation: health equity through action on the social determinants...

The final report of the World Health Organization’s (WHO) Commission on Social Determinants of Health (CSDH), Closing the gap in a generation: Health equity through action on the social determinants of health, was published in August 2008 (CSDH, 2008; Marmot et al., 2008). Welcoming the document on behalf of WHO, Director-General Margaret Chan noted: ‘‘the Commission’s main finding is straightforward: the conditions in which people are born, live, and work are the single most important determinant of good health, or ill health; of a long and productive life, or a short and miserable one’’ (Chan, 2008). The report presents an excellent overview and analysis of the range of structural factors that influence individual and population health, and makes a number of practical recommendations that seek to ensure that avoidable health inequalities are levelled out, so that everyone has an equal opportunity of leading a healthy life. Roughly around the time of publication of the CSDH report, and in the 60th anniversary year of the NHS, the UK Department of Health (DH) held a consultation on a draft NHS Constitution. The document aimed to set out the NHS’ fundamental values and principles and included a range of individual rights of NHS users, detailing also their responsibilities. A final version of the constitution was published in January 2009 (DH, 2009). Given the CSDH’s emphasis on the primary role of the social determinants of health (CSDH, 2007, 2008), what should we make of the DH’s initiative to introduce, for the first time in NHS history, explicit health-related responsibilities for individuals? Why talk about individual responsibility if yet further evidence has been produced that demonstrates the importance of environmental factors? For those sympathetic to the social determinants of health (SDH) approach, there seem to be three principal types of response: (i) to reject the DH’s move; (ii) to agree that it makes some sense, but to argue that it should