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    Rick Brush

    We are finding similar challenges in our Communities of Health work ( in the United States. While people intuitively grasp the idea of social determinants of health, it is difficult to sustain ongoing awareness and attention on these factors sufficient to do anything about them.

    A number of barriers exist. First, it is difficult to break from the prevailing frame, which views health primarily as a function of individual behavior and medical care. The individual-medical model of health dominates our systems, beliefs and language, and is continually reinforced in the way our nation thinks about, talks about and acts on health. And, when health is discussed in a broader context, counter-narratives tend to appear, overwhelming the potential for an expanded view of health.

    A second challenge has been demonstrating how social determinants impact specific stakeholder groups. For instance, it has been difficult to draw a direct causal linkage between harmful community conditions and the rising costs of health care paid for by an employer.

    Finally, even for those who are motivated to act, specific strategies for addressing the social determinants of health may seem elusive, impractical or insurmountable. As more than a few Communities of Health participants have expressed: “This is like trying to solve world hunger – what do you want me to do about it?”

    What we are learning is that nothing changes until people have the opportunity to discover for themselves what matters to health, and what we can do about it together. In short, we must un-learn and re-learn “health” as a direct, ongoing and collective experience of it.

    This is happening in a growing number of cities where people are coming together to uncover the broad set of factors driving health and illness in their communities. What they discover together forms the basis of collaborative action among an expanding group of stakeholders – citizens, business, government, education, health and other sectors – who realize the collective strengths, needs, and possibilities inherent in their community.

    Rick Brush

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    I appreciate the frustration and futility of working with the media on the social determinants of health. I am reading A While New Mind by Daniel Pink who reinforces what is not a new concept – science sees anecdote as the lowest form of science/evidence, which is true when researching causation, etc – but anecdote is the highest form of communication. Exhibit A would be Malcolm Gladwell and his gift in telling stories of science across themes that resonate with the public. While the things identified on the path dependency argument in this blog post are undoubtedly true, they lead one to wave the proverbial towel and say “what’s the use”. The reasons identified by Professor Gasher offer some light to work within, specifically storytelling as it relates to the SDOH. Sometimes we hope the media will tell the story for us – that’s their job. But since they’re obviously not doing it very well as this post relates, perhaps the profession of public health needs to take more ownership of this. As I have delivered lectures to university students, the story is always more effective than the graph in helping them receive a concept (stick figure art vs full color art). Daniel Pink mentioned also that the London Telegraph newspaper once sponsored a mini-saga contest (not sure if they still do). Mini-sagas are extremely short stories – just fifty words long. In his book are examples of how much creativity can be packed into fifty words. Perhaps we could do something similar for the SDOH? Hold a contest (I’m also reading Punished By Rewards by Alfie Kohn so this contest would need to be appropriately incentivized) for stories related to the SDOH and begin the wheel moving in this new direction. I would be willing to make a donation (I’m a regular joe, not a philanthopist – but think this is important enough to put my money where my mouth is) to see something like this happen to increase our capacity to tell the stories of the SDOH.

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    I doubt if Australia’s mainstream media is much different to Canada’s in this respect but I don’t know of any studies in Australia on media barriers to reporting on the SDH? But when you think about it, the SDH isn’t exactly headline grabbing stuff, well at least the way its currently presented to the media by most health professionals. I don’t believe it’s all about media disinterest or values, I think it has a lot do with the subject itself. Jargon, no doubt is a big part of the probelm. I mean, the term ‘social determinants of health’? Ask anyone in the street what they think this is, or means, or has to do with them? I’d be very interested in their response. It probably also has a lot to do with the way health professionals engage with the media. Approaches to the SDH often rely on changing systems, public policy and organisational practices and these types of conversations can quickly glaze the eyes of even the most seasoned jounalist. We need to use succinct, plain English that expalins the causal lnkages between SDH and health status.

    I think Raphael’s arguments against the mainstream media apply equally to a large chunk of Australia’s health system, which appears to have a distinct disinterest in the SDH and probably for similar reasons as the media and more – lack of understanding and knowledge about the ways SD impact on health and wellbeing; difficulty in placing the context of SDH within a disease framework; not seeing the relevance of the SDH to everyday health care; outcome focused, quick fix treatments that measure indiviual ‘wellness’; vested clinical interest etc.

    The problem is that for people who work in the social area of public health, to ‘give up’, as Raphael apparently has, means ‘giving in’ to ignorance and vested interests whether they be media or the health system. No one ever told me that working in public health would be easy.


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