Improving health will take a village
Improving health is too multifaceted to be left solely in the hands of those working in the health sector alone, according to the latest Healthy People 2020 Objectives for the Nation. A recent shift in national health priorities has led Healthy People, a program that sets the national agenda for health promotion and disease prevention, to add 'social determinants' into its 2020 goals.
Two papers published in the December issue of the journal Health Education & Behavior (HE&B), published by the Society for Public Health Education (SOPHE), examine the history of the Healthy People Objectives and the new integration of social determinants in Healthy People 2020.
In both papers, the authors examine the effects of poverty, education and social structure on health and conclude that the country's compass for health improvement must point beyond the diseases to address their root causes and forge new public and private health partnerships.
In their article, "Healthy People: A 2020 Vision for the Social Determinants Approach," U.S. Assistant Secretary for Health Howard K. Koh, MD, MPH, and colleagues outline the need for collective effort and an expanded way of thinking to make true impacts on public health. "Health starts where people live, labor, learn, play and pray. The social determinants approach makes the healthier choice the easier choice for all people throughout the life span."
Addressing social determinants, "could catalyze and broaden healthier public policies and private sector practices outside of what had been traditionally considered the public health domain," write the authors.
In an accompanying commentary, Lawrence W. Green, DrPH, of the University of California at San Francisco and John P. Allegrante, PhD, of Columbia University and editor-in-chief of HE&B, applaud the inclusion of social determinants in Healthy People 2020. They also outline the 40-year history, perspective and skills that the health education profession brings to the table in addressing social determinants.
Green and Allegrante point with pride to health education's pioneer work in social determinants through processes of community mobilization, policy advocacy, capacity building and equity. "The added value we were prepared to bring to the field of public health (in the 1960s and 70s) was a focus on populations and communities with an ecological perspective, their organization and mobilization for social change."
To make future progress in tackling the social determinants, Green and Allegrante call for systems thinking and for a new metric of health that goes beyond addressing the state of individual health and risk factors to also account the issues of context.
"Healthy People 1980-2020: Raising the Ante Decennially or Just the Name From Public Health Education to Health Promotion to Social Determinants?" by Dr. Lawrence W. Green and Dr. John P. Allegrante: heb.sagepub.com/content/38/6/558.full.pdf+html