De los determinantes sociales a la interdependencia social: teoría, reflexión y aplicación / From social determinants to social interdependency: Theory, reflection, and engagement

William Ventres, Shafik Dharamsi, Peter De Wetter, Robert Ferrer

Resumen


Marco Teórico: Los académicos y profesionales de la medicina y la salud pública han dedicado mucho tiempo y esfuerzo para definir lo que significa los determinantes sociales de la salud e identificar las desigualdades en los efectos. Desafortunadamente, los profesionales de la salud pueden creer erróneamente que el origen de los malos resultados de la salud no están relacionados con las formas por los cuales los factores sociales, económicos, políticos y ambientales se establecen y se mantienen.

Razonamiento: Introducimos el concepto de interdependencia social de la salud y la enfermedad para (1) reforzar la necesidad de considerar las causas fundamentales de los determinantes sociales, y (2) ser consciente de la responsabilidad comunal y personal para ayudar a reducir sus efectos. El desarrollo de una comprensión profunda de la interdependencia social en la práctica clínica, en la investigación de la salud pública y en la promoción de salud implica un proceso repetitivo de observación, reflexión y acción. Efectuar este cambio positivo dentro de esas áreas es una obligación compartida.

Conclusión: Desarrollando y aplicando un abordaje de interdependencia social significa ser consciente de nuestra interconexión humana. Este abordaje demuestra cómo vivimos en un mundo en el que no estamos tan separados unos de los otros para que no podamos beneficiarnos solo con imaginarnos y desear para los demás lo que deseamos para nosotros mismos, lo cual puede motivarnos a considerar nuestro trabajo como profesionales de la salud como una fuerza positiva, no solamente para atender a las enfermedades, si no también para promover la buena salud.

Palabras Claves: Actitudes de los profesionales en salud; Cultura; Inequidades en Salud; Salud Pública; Determinantes de Salud; Responsabilidad Social; Poblaciones vulnerables



Abstract

Introduction: Scholars and practitioners in medicine and public health have devoted significant time and effort to defining the social determinants of health and identifying resulting inequities in health outcomes. Unfortunately, however, health care professionals can be led to believe that the origins of poor health-related outcomes are disconnected from the ways in which social, economic, political, and environmental factors are established and maintained.
Discussion: We introduce the concept of social interdependency in health ¬and illness as a way to (1) reinforce the need to identify the root causes of social determinants, and (2) accept not only personal but also shared responsibility for acting to ameliorate their effects. Developing a sound understanding of social interdependency in clinical practice, public health research, and health care advocacy involves an iterative process of observation, reflection, and action. Effecting positive change within these disciplines is a shared obligation.
Conclusion: Developing and applying a social interdependency approach means appreciating our human interconnectedness This approach showcases how we live in a world where none of us is so separate from another that we cannot benefit by envisioning and desiring for others what we might desire for ourselves, and can motivate us to consider work in the health professions as a force not only to attend to disease, but also to encourage health.
Keywords: Attitude of health personnel; bioethics; culture; health inequities; public health; social determinants; social responsibility; vulnerable populations

Texto completo:

Sin título

Referencias


ferencias

World Health Organization. What are the social determinants of health? Geneva, Switzerland. 2013. Available at: http://www.who.int/social_determinants/sdh_definition/en/.

Kunitz SJ. The health of populations: general theories and particular realities. New York: Oxford University Press; 2007.

World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva, Switzerland: World Health Organization; 2008.

Marmot M, Wilkinson R. The social determinants of health. 2nd ed. Oxford, UK: Oxford University Press; 2005.

Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep. 2014;129 Suppl 2:19-31.

Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med. 1994;39(7):887-903.

Porter D. How did social medicine evolve, and where is it heading? PLoS Med. 2006;3:e399. doi: 10.1271/journal.pmed.0030399

Breilh J. Epidemiología crítica: ciencia emancipadora e interculturalidad. Buenos Aires, Argentina: Lugar Editorial; 2003.

Spiegel JM, Breilh J, Yassi A. Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program. Global Health. 2015;11:9. doi: 10.1186/s12992-015-0091-2.

Johnson DW, Johnson RT, Smith K. The state of cooperative learning in postsecondary and professional settings. Educ Psychol Rev. 2007:19:15-29.

Ventres WB. Cultural encounters and family medicine: six lessons from South America. J Am Board Fam Pract. 1997;10(3):232-6.

Dharamsi S, Woollard B, Okullo I, Kendal P, Macnab A. Health promoting schools as learning sites for physicians in-training. Health Educ. 2013;114(3):186-96. doi: 10.1108/HE-09-2013-0048

Ferrer RL. A piece of my mind: within the system of no-system. JAMA. 2001;286(20):2513-4

Farmer P, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical medicine. PLoS Med. 2006;3:e449. doi: 10.1371/journal.pmed.0030449.

Ventres W, Kravitz JD, Dharamsi S. PEARLSS: key forces that influence social determinants and shape health outcomes. Acad Med. In press.

Metzl JM, Hansen H. Structural competency: Theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126-33. doi: 10.1016/j.socscimed.2013.06.032

Silver M. If you shouldn’t call it the third world, what should you call it? NPR. January 4, 2015. http://www.npr.org/blogs/goatsandsoda/2015/01/04/372684438/if-you-shouldnt-call-it-the-third-world-what-should-you-call-it. Accessed July 30, 2015.

Sen A. Development as freedom. 2nd ed. New York, NY: Oxford University Press; 2001.

Ventres W, Gusoff G. Poverty blindness: exploring the diagnosis and treatment of an epidemic condition. J Health Care Poor Underserved. 2014;25(1):52-62. doi: 10.1353/hpu.2014.0025

Bourgois P, Holmes SM, Sue K, Quesada J. Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Acad Med. 2016; 2015 Aug 25. [Epub ahead of print]

Phillips SP. Defining and measuring gender: a social determinant of health whose time has come. Int J Equity Health. 2005;4:11. doi: 10.1186/1475-9276-4-11

Kawachi I, Kennedy BP, Lochner K, Prothrow-Smith D. Social capital, income inequality and mortality. Am J Public Health. 1997;87(9):1491-8.

Navarro V, Muntaner C, Borrell C, Benach J, Quiroga A, Rodriguez-Sanz M, Vergés N, Pasarin MI. Politics and health outcomes. Lancet. 2006;368(9540):1033-7.

Stoddart MCJ. Ideology, hegemony, discourse: a critical review of theories of knowledge and power. Soc Thought Res. 2007;28:191-226.

Galtung J. A structural theory of imperialism. J Peace Res. 1971;8(2):81-117.

Verkerk MA, Lindemann H. Theoretical resources for a globalised bioethics. J Med Ethics. 2011;37(2):92-6. doi: 10.1136/jme.2010.036830

Waitzkin H, Iriart C, Estrada A, Lamadrid S. Social medicine then and now: lessons from Latin America. Am J Pubic Health. 2001;91(10):1592-601.

Green M, Hulme D. From correlates and characteristics to causes: thinking about poverty from a chronic poverty perspective. World Dev. 2005;33(6):867-79. Doi: 10.1016&/j.worlddev.2004.09.013

Dharamsi S, Ho A, Spadafora SM, Wollard R. The physician as health advocate: translating the quest for social responsibility into medical education and practice. Acad Med. 2011;86(9):1108-13. doi: 10.1097/ACM.0b013e318226b43b

Nichter M. Global health: why cultural perceptions, social representations, and biopolitics matter. Tucson, AZ: University of Arizona Press; 2008.

Garrafa V, Porto D. Intervention bioethics: a proposal for peripheral countries in a context of power and injustice. Bioethics. 2003;17(5-6):399-416.

Ventres W, Haq C. Toward a cultural consciousness of self-in-relationship: from “us and them” to “we”. Fam Med. 2014;46(9):691-5.

Hesserl S. Time for Outrage! London, UK: Charles Glass Books; 2011.

Hunt MR, Schwartz L, Sinding C, Elit L. The ethics of engaged presence: a framework for health professionals in humanitarian assistance and development work. Dev World Bioeth. 2014;14(1):47-55.

Ventres WB. Building power between polarities: on the space-in-between. Qual Health Res. 2016;26(3):345-350.

Breilh J. La determinación social de la salud como herramienta de transformación hacia una nueva salud pública (salud colectiva). Rev Fac Nac Salud Pública. 2013;31 Supl 1:13-27. Available at: http://www.redalyc.org/articulo.oa?id=12028727002.

Ventres WB, Fort MP. Eyes wide open: an essay on developing an engaged awareness in global medicine and public health. BMC Int Health Hum Rights. 2014;14:29. doi: 10.1186/s12914-014-0029-4.

Dharamsi. S. Moving beyond the limits of cultural competency training. Med Educ. 2011;45(8):764-766. doi: 10.1111/j.1365-2923.2011.04044.x.

Greenhalgh T, Russell J. Evidence-based policymaking: a critique. Perspect Biol Med. 2009;52(2):302-14. doi: 10.1353/pbm.0.0085

Hart JT. The inverse care law. Lancet. 1971;i(7696):405-12.

Labonte R. Global action on social determinants of health. J Public Health Policy. 2012;33(2):139-47. doi: 10.1057/jphp.2011.61

Bainbridge L, Grossman S, Dharamsi S, Porter J, Wood V. Engagement studios: students and communities working to address the determinants of health. Educ Health (Abingdon). 2014;27(1):78-82. doi: 10.4103/1357-6283.134330.

Dawson A, Jennings B. The place of solidarity in public health ethics. Public Health Rev. 2012;34(5):65-79. doi: 10.1002/hast.490

Westerhaus M, Finnegan A, Haidar M, Kleinman A, Mukherjee J, Farmer P. The necessity of social medicine in medical education. Acad Med. 2015;90(5):565-8. doi: 10.1097/ACM.0000000000000571

Ventres W, Dharamsi S. Socially responsible medical education: the REVOLUTIONS framework. Acad Med. 2015;90(12):1728. doi: 10.1097/ACM.0000000000000872

Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005; 83(3):457–502.

UN System Task Team on the Post-2015 UN Development Agenda. Social protection: A development priority in the post-2015 UN development agenda. 2012. Accessed at: http://www.un.org/millenniumgoals/pdf/Think%20Pieces/16_social_protection.pdf.

Lopéz Arellano O, Escudero JC, Carmona LD. Social determinants of health: perspective of the ALAMES working group on social determinants. Soc Med. 2008;3(4):253-64. Accessed at: http://www.socialmedicine.info/index.php/socialmedicine/article/view/271/529

National Academies of Sciences, Engineering, and Medicine. A framework for educating health professionals to address the social determinants of health. Washington, DC: The National Academies Press; 2016. doi: 10.17226/21923.

Ventres WB, Wilson CL. Beyond ethical and curricular guidelines in global health: attitudinal development on international service-learning trips. BMC Med Educ. 2015;15:68. doi: 10.1186/s12909-015-0357-7.

Ventres WB. The Q-list manifesto: getting things right in generalist medical practice. Fam Syst Health. 2015;33(1):5–13. doi: 10.1037/fsh0000100


 

Please feel free to comment on this article:

blog comments powered by Disqus


Oficinas Editoriales: Asociación Latinoamericana de Medicina Social (ALAMES) Región Cono Sur, Cassinoni 1440 – 802, CP 11200, Montevideo, Uruguay & ALAMES Región México, A.C., San Jerónimo 70 – 1, Col. La Otra Banda, CP 01090, México, D.F.
E-correo: socmed.medsoc@gmail.com
Teléfono: (52-55) 51 71 96 19

Departmento de Medicina Familiar y Social de la Escuela de Medicina Albert Einstein, Centro Médico Montefiore, Bronx, New York, 10461