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On the Social Determinants of Health, Infectious Disease, and the Prevention Paradox

Posted: 02 Nov 2010 10:31 AM PDT

The Centers for Disease Control has released an excellent new White Paper entitled Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States (pdf). There is no Abstract, but here is an excerpt from the Executive Summary:

today there are groups that carry a severe and disproportionate burden of our focus diseases. To address this imbalance, we must complement individual- level interventions, intended to influence knowledge, attitudes, and behaviors, with new approaches that address the interpersonal, network, community, and societal influences of disease transmission and health. Evidence suggests that programs that comprehensively address health where we live, work, learn, and play can have greater impact on health outcomes at the population level than programs utilizing interventions aimed solely at individual behavior change.*

This last point is particularly important, since it reflects some of the underpinnings of the prevention paradox I have mentioned here on MH Blog, as well as a developing literature suggesting that individualistic, so-called "agentic" interventions depend to a large extent for their success on the resources available to individuals (e.g., Capewell and Graham 2010). Not only are such interventions therefore less likely to be successful among those socially, economically, and politically disadvantaged populations that bear disproportionate burdens of disease, but as a result may also expand inequities.

Thus the argument for a whole population approach, one that addresses the structural determinants of health and illness across and within populations.

Thoughts?

*(Notes omitted).