a global framework for emerging research on the social determinants of health sharon friel professor...
TRANSCRIPT
A global framework for emerging research on the social determinants of health
Sharon FrielProfessor of Health Equity and Director, Regulatory Institutions Network,
Director, Menzies Centre for Health Policy, The Australian National University
1. What are the questions?
2. What type of evidence is needed to answer the questions?
3. What architecture is needed?
Socio-economic gradient in health, Australia
0
2
4
6
8
10
12
14
$5-<10K $10-<20K $20-<30K $30-<40K $40-<50K $50-<70K >=$70K
Perce
ntage
Household income
Diabetes
0
5
10
15
20
25
30
35
$5-<10K $10-<20K $20-<30K $30-<40K $40-<50K $50-<70K >=$70K
Perce
ntage
Household income
Depression
Data source: 45 and Up Study (Korda et al, under review)
Living & Working Conditions
e.g.PlanningHousing
Employment
Health Care Systemse.g.
Equitable access to careHealth Promotion
Power, Money & Resourcese.g.
Trade and investmentTaxationRacism
Health Equity
Research Domains
Health equity
Seven political domains that shape health and health inequity
Intellectual property
Trade and investment treaties
Food
Corporate activity
FinanceMigration
Armed conflict
Ottersen etal. The Lancet–University of Oslo Commission on Global Governance for Health The Lancet, 2014
Chief Investigators: Friel, Bammer, Gleeson, Kay, ThowAssociate Investigators: Labonte, Snowdon, Stuckler
Trade policy: Maximising benefits for nutrition, food security, human
health, and the economy
ARC Discovery Grant DP130101478
2013-2015
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
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)
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
Evaluation of the impact of health-sector policy and
programs on health equity;Applying a health equity lens to non-health sector
policy and programsUnderstanding how SDH
and health equity gets onto the agenda
Understanding the barriers and opportunities:
systems, processes and actors
What does SDH policy and action look like
Framing the question
1. Lack of public awareness about the SDH2. Prominent ideology3. Human attribution biases4. 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
Shaping the public discourse
Hayes et al. Social Science & Medicine 64 (2007) 1842–1852
Different kinds of research to answer different questions
Community trialsEconomic analysis
Case studies
Policy & regulatory analysis
Epidemiology
Natural experiments
Natural sciences
Discourse/framing analysis Network analysis Systems science Realist evaluations
Emerging theory-informed methods
Disciplinary diversity
• Epidemiology• Health services• Psychology• Sociology• Anthropology
For example
• Law• Economics• Political science• Public administration• Systems science
Questions of training
1. Disciplined mind
2. Synthesizing mind
3. Creative mind
4. Respectful mind
5. Ethical mind
Minds for an equitable future