It is well understood that housing, access to nutritious foods, livable wages and a host of other factors outside the doctor’s office influence how long and how well we live. But what shapes those conditions? Who and what decide who receives the resources necessary to thrive?
For more than a dozen years, the World Health Organization (WHO) and other public health experts have pointed to a “wider set of systems and forces” that have either promoted or harmed our health. In a landmark 2010 paper, WHO called this the structural determinants of health inequalities and deemed it an avoidable, human-created system. These overarching processes shape the social determinants and increase social stratification and an unequal distribution of resources, according to WHO.
As those in public health – including County Health Rankings & Roadmaps (CHR&R) – look to better explain what creates the social determinants of health, it is worth noting how and where structural determinants exist and the role power dynamics play. Doing so could better inform public health research, which would lead to more effective policymaking, more equitable outcomes and better health for everyone.
The WHO paper argued power operates in economic, social and political dimensions. Concentrating it in the hands of just a few produces unfair, unjust and unequal conditions. For example, the power some corporations and wealthy individuals have wielded has shaped policies and political decisions that have disproportionately harmed people’s health, especially those who have been historically and systematically marginalized and oppressed.
The field has not yet reached consensus on which categories to consider part of the structural determinants of health. The WHO paper included governance, culture, societal values, epidemiological conditions and social, public and economic policy. More recent publications have proposed categories such as commercial, political, legal, environmental, settler colonial, historical and moral determinants.
Those in public health hold an opportunity to clarify what shapes health and to illuminate power’s role. We at CHR&R believe we can reimagine and shift resources, structures and power to build a transformed future together.
Let us know how you define structural determinants and whether your organization is wrestling with the same questions around power, policy, research and models of health. Contact us at [emailprotected].
