On the 19th May, the Universitat Pompeu Fabra (UPF) hosted the 2023 Presentation of the International Journal of Social Determinants of Health and Health Services (IJSDOHS). The event brought together experts in the social determinants of health (SDOH) from across the world to explore and discuss the major questions and future pathways for research, policy and action regarding the SDOH and health services. 

The following article summarises the key issues and discussions that proceeded in Session 2 of the event.

The second session, moderated by Carles Muntaner, responded to the question “What kind of research is needed in the field of SDOH?”. The speakers were Megan Reynolds (University Utah, US) and Jerzy Eisenberg-Guyot (Columbia University Mailman School of Public Health, US), and the discussant was Seth Prins (Columbia University Mailman School of Public Health, US). Unfortunately, the programmed speaker Onur Hamzaoglu (Kocaeli Academy for Solidarity - Turkey) was unable to participate due to illness. 

To start, Reynolds focused on the impact of power relations on health, starting her presentation with the historical context of how the SDOH have been understood since the 1980s. She introduced the Health Power Relations theory, which proposes that power relations affect how socioeconomic resources are translated into health-relevant resources through a variety of mechanisms. She added that Health Power Relations “privileges the context that puts people at risk, looking at the causes of the causes of the causes … through stratification, commodification, discrimination and devitalisation.” Reynolds described devitalisation as “an act of depriving an individual of vitality, rigour, or affectiveness relative to socio-economic factors.” This theory takes into consideration not only the distribution of goods, as in classical politics, but also the social relations that affect the starting point of distribution and people’s capabilities to access and harness the goods that have been distributed. The importance of focusing on power relationships, she emphasised, is that it moves the narrative away from individual characteristics as explanatory fundamental mechanisms for health outcomes and inequities, and towards the structural causes: “When we say race or sex is a cause for poor health, what we really mean is that racism or sexism is a cause for poor health.”

Eisenberg-Guyot’s presentation emphasised the need for more research into class relations and their impact on health inequities. He explained the differences between relational and stratificationist approaches to health inequities research, i.e. that relational approaches take into consideration how social relations — such as class power dynamics — shape and influence health inequities, whereas stratificationist approaches analyse individuals’ attributes — such as income and education — as the causes of health inequities. He stated that, while stratificationist approaches provide strong indicators of morbidity and mortality, they “ignore social relations that affect health through pathways other than socioeconomic status,” and are therefore “less powerful than relational ones in identifying the root causes of health inequities.” Eisenberg-Guyot referred to a study that found that working class mortality tripled from 1996-2019, arguing that increasing health inequalities call for more research and data on class relations as a SDOH. He concluded that “a final urgent question [that must be addressed] is how interventions can eliminate or mitigate class inequalities.”

Following this, Muntaner made a short presentation to compensate for Onur Hamzaoglu’s absence. He reinforced the points made by both Reynolds and Eisenberg-Guyot, agreeing on the need for both relational analyses of health inequalities and a focus on political, economic and cultural determinants of health inequalities. He highlighted racialised patriarchal capitalism and neo-feudalism as key structural (i.e. political, economic and cultural/ideological) determinants of health, shaping the context within which people live. He closed with the following statement: “We need to uncover the mechanisms and the dynamics that go from power inequalities to economic exploitation and [social] attitudes, without leaving anything out.”

Responding to these presentations, Prins highlighted the issues surrounding social change and the researcher’s role in society, arguing that traditional research methods are not well equipped for dealing with the relational aspects of current challenges such as capitalism, white supremacy and patriarchy. He called for researchers to be explicit about the conflicts and struggles that exist in the world, and to interrogate what kinds of research are useful for those struggling for justice, rather than just documenting the world. He added that "Academics should make it a priority to be connected to movements and fights for health equity on the ground.” He also argued that a focus on the SDOH can help to show why — and which — struggles are necessary and important, and can be used to propel change towards greater health equity. Prins also highlighted that the nature and scale of the response to the climate crisis is a crucial ecosocial determinant of health and demands careful attention. 

The presentations were followed by a discussion on the terminology regarding the SDOH, as well as the importance of reflecting on methodology, positionality and subjectivity in public health research.

The full video of this session can be found here.