History of the Social Determinants of Health: Global Histories, Contemporary Debates (review)

The extensive literature produced over the past five years on the area broadly defined as social determinants of health would give the impression that this is a new area of scholarship, triggered by the overwhelming evidence that the level of health of populations does not have much to do with medical care. If medical care is not so important, what is important? The answer, in this new literature, is social determinants, which include social, economic, and cultural interventions outside the realm of medicine. This new bibliography reached its height with the report of the World Health Organization (WHO) Commission on Social Determinants of Health, much quoted and cited worldwide—except in the United States, where, under the Bush administration, such a commission and its report were seen as threatening to the established order. The major media in the United States practically ignored the report. This was not so in Europe, where it had a considerable effect. Several countries, led by Sweden, had their governments develop national health plans that focused not so much on medical care as on interventions such as income redistribution, housing reforms, and other social interventions.

Yet, the study of social determinants of health is not new. Actually, it is quite old. It is public health at its best. And this is why the collection under review here is so timely. The book is edited by three scholars and historians of medicine at University College, London, and consists of eighteen chapters. In the first four chapters, Alison Bashford presents the historical collection of interregional differences in health in Australia and Papua New Guinea; Paul Greenough analyzes the history of public health in Asia; Randall M. Packard writes similarly about the evolution of public health in Africa (combining studies of cultural and behavioral factors with structural determinants of health); and Jan Sundin and Sam Willner focus on Europe, especially Sweden. These chapters read almost like case studies—if continents, such as Asia and Africa, can be grouped as case studies, which is not easy. The case of Sweden is more manageable, and this chapter makes entertaining reading.

The next four chapters are equally interesting. Virginia Berridge writes—or, I should say, rewrites—the history of one of the most influential reports in the Anglo-Saxon world, the Black Report, providing new information of great interest. Stephen J. Kunitz writes on the association between sex, race, and social stratification (the latter was formerly known as class structure) and mortality. Kasturi Sen and Abla Mehio-Sibai analyze an unfortunately frequent event: the targeting of civilian populations in large-scale wars and contemporary violence; their analysis focuses on Lebanon but could have been done for many other parts of the world. Roderick J. Lawrence discusses the relationship between urban development and health. All four chapters deal with areas of great relevance.

A critical observation that could be made on this first half of the book is that these chapters are fairly straightforward and contain highly controversial statements that are presented as matters of fact. This is why it comes as a relief that the next two chapters include debates between Anne-Emanuelle Birn (who details how targeted social programs are less effective than universal entitlement programs in reducing infant mortality) and Roderick J. Lawrence, on the one hand, and Socrates Litsios, on the other. Litsios, who used to work for the WHO, questions some of the positions put forward by the other authors, making the reading of the exchange more entertaining. I wish that this approach had been used more extensively in the volume.

The last part of the book contains five chapters. Patrice Bourdelais looks at the impact of progress (insufficiently defined) on health, raising a large number of questions that remain unanswered. Imrana Qadeer notes the impact of several policies on health, focusing on India. Simon Szreter...