Professional Documents
Culture Documents
Part I
Marcio Ulises Estrada Paneque. MD. PhD.* Genco Estrada Vinajera. MD.** Caridad Vinajera Torres. PhD.***
Authors.
* Doctor in Sciences. Titular Professor. First & Second Degree specialized in Paediatric and Public Health.
** First Degree specialized in General and Integral Medicine. Resident in Neurophisiology. *** Doctor in Sciences. Titular y Consultant Professor. Philologist.
Objectives.
To approach the equity in health like a value that translates theory of social justice and like basic factor for the right to the health. Recognize and identify health inequities like strategic element for the formulation of more equitable public policies. Analyze the inter-sectoral policies and strategies arranged from the point of view of SDH.
Analyze the recommendations that emanate of the WHOS SHD Commission and their knowledge networks.
Thematics.
Values, approaches and perspective for the action to identify the foundations of the SDH and their potentiality to formulate policies. Principles of social justice, fairness in health and human rights and theirs relations with actions on SDH. Structural and intermediate mechanisms in the production of inequities in health between population groups and territories.
SDH.
The SDH talk about to the specific characteristics and the routes by means of which the social conditions affect the health, which they can be altered through documented actions.
These social processes and conditions are essential factors that determine limits or exert pressures, although without being necessarily determinist in the sense of a fatalistic determinism.
Achieve social equity in health implies a reduction of the excessive load of bad health between the groups more affected by the social inequities, to diminish the social inequalities and to improve the mean levels of general health.
ETDD.
It considers how the population health from the social conditions is generated, tie necessarily with biological processes in all the temporo-space scales, from subcellular level to the world-wide, or from nanosecond to the millenium. The cumulative interactions between exposition, susceptibility and resistance, express accord their distribution factors in multiple levels (individual, districtal, regional, national, international or supranational) or in multiple dominions (home, work, school), in relation to ecological nests and in processes with multiple space and time scales.
ETDD.
Express knowledge in relation to institutions (government, prived & public sector), community, home and individuals, with the responsibility of the epidemiologists and scientists with respect to used or not used theories, to explain the social inequalities in the health. Given the existence of complementary causes on different scales and levels, epidemiologic studies must specify scales and levels of analysis, and consider their benefits and limitations
ETDD.
Its epidemiologic explanations consider the temporal and space distribution of the disease, as much persistent and changing.
More than add " simply; biology" to the social analyses " or " social factors " to the biologic analyses, ecosocial conceptual frame is an systematic integrated approach, able to generate new hypotheses, without look for simple factors identified by other approach (Eg. biological) in terms of other (Eg. social).
SHD. Controversy.
Is controversial for some one the expressions determinants of health and determinants of health inequities
For some, first is equivalent to epidemiologic risk factors and the second have a transforming character, because it leads to understand the unjust hierarchies of social structures and reveals the true causes of health inequities. Debate is not closed, SDH polysemy speaks about the necessity of a shared language, that favors a more articulated political action.
SHD. Reality
Understand health-disease process from this perspective, offers a broad politicized outlook and shows the necessity of more integrated and agreed policies (social governments, movements and NGO), to obtain major quality of life. Poverty, schooling, nutritional insecurity, exclusion, social discrimination, quality of the house, lack of hygiene and little labor qualification constitute determinants factors of health inequality, morbidity and mortality.
For what treat population ... and later put them in the same insalubre life conditions ?
It does not mean that equitable HS stops having importance. It must be clear that sometimes, HS is same part of the problem and that new strategies are essential to eliminate the inequities in health.
What mechanisms lead to us from original causes to the present differences in the situation of observed health?
Where and how are possible interventions to reduce the inequities in health?
SDH. Influences.
SDH influence is not only demonstrated when we compare distance between top and base of the social stratification, but also when we analyze indicators of health in relation to other variables throughout all the social stratification. Analysis would not focus attention only in situation of people who are in the poverty levels (poor between poor). Analysis of social distribution throughout all health social stratification indicates that all we are implied.