23 Feb

Why global health needs more attention – reflections on writing a book on this topic

Posted By polity_admin_user


In our latest book Global Health: An Introductory Text we have drawn upon a social scientific lens to critically consider this topic area, because we believe that the social determinants of health should be at the forefront of analyses in this area. That is not to say that the physical and biological aspects of global health are not important, in fact, we do make mention of these at times within the chapters. However, like many others, we believe that a social scientific perspective brings a new, valuable dimension warranting wider attention.

Media reporting within the UK often draws our attention to deadly infectious diseases in other countries, that may pose a threat to us. Recent notable examples include Zika and Ebola. Yes, these are contemporary global health issues, yes these remain concerning but what about power, policies, equality and ethics? These issues relate to the social context influencing our daily lives, and remain important in determining our health. How else can we explain inequalities in global death rates, and access to care? Children in higher income countries fare better than those in poorer countries in terms of their chances of dying from a wide range of conditions, and take for granted health care, education and basic human rights. How can this be considered fair and just?

We argue throughout our book that contemporary global issues and health challenges remain related to power, policies, and the social context underpinning them. Social determinants are part of the causal pathway of many global health challenges, and remain linked to communicable and non-communicable disease patterns. The World Health Organisation (2017) define the social determinants of health as ‘the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of everyday life’ (http://www.who.int/social_determinants/en/).

The importance of social determinants in shaping health and health experience has long been highlighted in the work led by Sir Michael Marmot and his team in the Commission on the Social Determinants of Health (CSDH 2008). The work of this commission emphasises the ‘causes of the causes’, namely how the conditions in which we live our lives directly and indirectly affect our health. Closer examination of these conditions tends to show that those who live in relative disadvantage suffer more than those who are better off (whether financially or socially). This leads to inequality and inequity and, ultimately, comes down to the issue of social justice.

As part of the continuing work of the CSDH a specific conceptual framework has been created to further understanding of the social determinants of health. This was developed by Solar and Irwin (World Health Organisation, 2010). Using this framework throughout our book, we have been able to explore the global distribution of health and wellbeing, global patterns of disease, inequalities in global health specifically in relation to social position and material circumstances, the wider determinants of health, global health systems, governance and policy, global health protests and finally, the contemporary challenges for global health.

Central to a social determinants perspective are issues of equity and equality and, as such, these recur as key themes within this book. Alongside issues of inequity and inequality we also consider power as a key theme. We present a critical take on power, who has power and who does not, and how this impacts on health outcomes and health experience. Power is inextricably linked to social determinants. Generally, the wealthier someone is, the more power they have to affect change in their own lives and to influence others. Power also exists at a state or governmental level and is therefore tied up with political agenda and governance. In addition to power and health inequalities there are two more key themes within this book which we believe have paramount importance in discussing global health from a social science perspective. The first is a critique of neoliberalism and the second is ethics.

We have drawn on a wide range of diverse issues to illustrate our key points – these vary enormously from climate change to reproductive health, but our analysis is drawn together by the evidence which illustrates how the social determinants remain crucially important to understanding global health.

Louise Warwick-Booth is a Reader in Health Promotion Research at Leeds Beckett University. Ruth Cross is Course Director in Health Promotion at Leeds Beckett University. Their latest book, Global Health Studies: A Social Determinants Perspective, is now available from Polity. They are also authors, with Diane Lowcock, of Contemporary Health Studies: An Introduction.