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A global framework for emerging research on the social determinants of health

A global framework for emerging research on the social determinants of health. Sharon Friel Professor of Health Equity and Director, Regulatory Institutions Network, Director, Menzies Centre for Health Policy, The Australian National University. What are the questions?

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A global framework for emerging research on the social determinants of health

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  1. A global framework for emerging research on the social determinants of health Sharon Friel Professor of Health Equity and Director, Regulatory Institutions Network, Director, Menzies Centre for Health Policy, The Australian National University

  2. What are the questions? What type of evidence is needed to answer the questions? What architecture is needed?

  3. Point 1. What’s the question?

  4. Illuminating health inequities

  5. Socio-economic gradient in health, Australia Data source: 45 and Up Study (Korda et al, under review)

  6. Understanding the causes of health inequities

  7. Re-framing the question "why are the poor behaving this way?” "why are they poor?”

  8. Health inequities are socially produced

  9. Research Domains Health Care Systems e.g. Equitable access to care Health Promotion Living & Working Conditions e.g. Planning Housing Employment Health Equity Power, Money & Resources e.g. Trade and investment Taxation Racism

  10. Seven political domains that shape health and health inequity Intellectual property Finance Migration Health equity Corporate activity Armed conflict Food Trade and investment treaties Ottersenetal. The Lancet–University of Oslo Commission on Global Governance for Health The Lancet, 2014

  11. Trade policy: Maximising benefits for nutrition, food security, human health, and the economy ARC Discovery Grant DP130101478 • 2013-2015 Chief Investigators: Friel, Bammer, Gleeson, Kay, Thow Associate Investigators: Labonte, Snowdon, Stuckler Friel et al. A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement. Globalization and Health 2013, 9:46

  12. Domain 1 aim • develop a conceptual model of the system linkages between trade, food, the economy, society and health outcomes, • investigate how systems science can be used to support integrated trade, food, and health policy-making Domain 2 aim • produce quantitative evidence of diet related health effects of a trade agreement (the TPP) Domain 3 aim • characterise the main stakeholder groups and institutions involved in the TPP negotiations, within Australia and at the international level • assess the capacity of different modes of trade governance to achieve coherence between the goals of trade and health sectors (with respect to food and nutrition)

  13. Does social spending save lives? Slide: David Stuckler

  14. Greek Tragedy • >200% rise in HIV infections • 40% rise in homelessness • 50% rise in people unable to access medical care • 40% increase in infant mortality • ~60% reported increase in suicides • Kentikelenis et al. Health effects of financial crisis: omens of a Greek tragedy. Lancet 2014

  15. Economic growth in Iceland and Greece Slide: David Stuckler

  16. What works to improve health equity and how

  17. Evaluation of the impact of health-sector policy and programs on health equity; Applying a health equity lens to non-health sector policy and programs Framing the question Understanding how SDH and health equity gets onto the agenda What does SDH policy and action look like Understanding the barriers and opportunities: systems, processes and actors

  18. Reflection from Health Ministers Baum Etal. Social Science and Medicine 2013

  19. Social innovation

  20. The art and science of advocacy and communication

  21. Shaping the public discourse • Lack of public awareness about the SDH • Prominent ideology • Human attribution biases • Journalistic norms and practice …In two-thirds of the 50 stories [on television news], the main message was that individuals were personally responsible for their weight… Bonfiglioli 2007 Hayes et al. Social Science & Medicine 64 (2007) 1842–1852

  22. Point 2. What type of evidence/analysis is needed to answer the question

  23. Evidence for policy Evidence of policy

  24. Technical analysis Political analysis

  25. Policy Market Social innovation

  26. Different kinds of research to answer different questions Epidemiology Community trials Economic analysis Natural experiments Policy & regulatory analysis Case studies Natural sciences

  27. Emerging theory-informed methods • Discourse/framing analysis • Network analysis • Systems science • Realist evaluations

  28. Point 3. What architecture is needed

  29. Knowledge Skills Funding and dissemination

  30. Disciplinary diversity For example • Epidemiology • Health services • Psychology • Sociology • Anthropology • Law • Economics • Political science • Public administration • Systems science Questions of training

  31. Minds for an equitable future Disciplined mind Synthesizing mind Creative mind Respectful mind Ethical mind

  32. Shifting the paradigm with appropriate evidence • Flood the funders • Be on grant selection committees • Review every related article that you possibly can

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