Factors affecting health sector involvement in public policies addressing the social determinants of health: a critical realist case study of cash transfers in Ghana

2020 ◽  
Vol 58 (4) ◽  
pp. 180-198
Author(s):  
Ebenezer Owusu-Addo ◽  
Andre M. N. Renzaho ◽  
Ben J. Smith
Evaluation ◽  
2018 ◽  
Vol 25 (2) ◽  
pp. 224-244 ◽  
Author(s):  
Ebenezer Owusu-Addo ◽  
Andre M. N. Renzaho ◽  
Ben J. Smith

Cash transfers are a widely adopted social policy initiative for addressing poverty and vulnerability. Cash transfers’ exponential growth in low- and middle-income countries provides a unique opportunity to advance our understanding of how they work to impact the social determinants of health. This article reports on a realist qualitative approach to developing an initial program theory about the role of cash transfers in tackling the social determinants of health. A set of 12 initial hypotheses regarding how cash transfers might work to address the social determinants of health were developed from the data. Cash transfer key mechanisms of change found in the study included political will and leadership and news media framing at the macro level, collaboration and intersectoral working at the meso level, and household motivation, empowerment, choice making, awareness raising and risk-taking behaviour at the micro level. This study has developed initial hypotheses that can be tested and refined in future studies using a realist approach.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fiona Haigh ◽  
Lynn Kemp ◽  
Patricia Bazeley ◽  
Neil Haigh

Abstract Background That there is a relationship between human rights and health is well established and frequently discussed. However, actions intended to take account of the relationship between human rights and social determinants of health have often been limited by lack of clarity and ambiguity concerning how these rights and determinants may interact and affect each other. It is difficult to know what to do when you do not understand how things work. As our own understanding of this consideration is founded on perspectives provided by the critical realist paradigm, we present an account of and commentary on our application of these perspectives in an investigation of this relationship. Findings We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship. Those implications include the need to theorise possible entities involved in the relationship together with their distinctive properties and consequential power to affect one another through exercise of their respective mechanisms (ways of working). This theorising work enabled us identify a complex, multi-layered assembly of entities involved in the relationship and some of the array of causal mechanisms that may be in play. These are presented in a summary framework. Conclusion Researchers’ views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. We demonstrate that by attending to these views, which are founded in their paradigm positioning, researchers can make more progress in understanding the relationship between human rights and the social determinants of health, in particular when engaged in theorizing work. The same approaches could be drawn on when other significant relationships in health environments are investigated.


2020 ◽  
pp. 152-156 ◽  
Author(s):  
Evelyne de Leeuw

The ‘Ottawa Charter for Health Promotion’ (1986) remains a benchmark for the global health promotion community, but the context for health promotion has changed with increasing recognition of the significance of inequalities in health. Health promotion is a key strategy to deal with the social determinants of health that create these inequities. Attention has shifted from the mere recognition that all public policies may impact on health to active strategies and actions to move health concerns into all policies. Clinicians are key actors in shaping social and cultural priorities and beliefs: they should be committed to the reduction of health inequity, with health promotion as a core commitment and responsibility.


Author(s):  
Nicholas B. King

This chapter examines the interplay between normative judgments and empirical research. Using a case study of recent work on the social determinants of health, the author argues that three domains that are normally thought of as conceptually and disciplinarily independent—epistemology, scientific methodology, and normative judgment—are in fact closely intertwined. When considering issues related to health inequalities and social justice, keeping these domains separate leads to poor science, poor theorizing, and, ultimately, poor policy choices. The author identifies three problems with the claim that in order to reduce health inequalities and improve population health, we are morally compelled to address the social determinants of health, through interventions that redistribute social or economic resources in a more fair or just manner. The problems are (1) assuming that data are the neutral products of objective scientific investigations; (2) misunderstanding causality and counterfactual reasoning; and (3) blind belief in the consonance of the good.


2017 ◽  
Vol 3 (Suppl 1) ◽  
pp. e000603 ◽  
Author(s):  
Angela Donkin ◽  
Peter Goldblatt ◽  
Jessica Allen ◽  
Vivienne Nathanson ◽  
Michael Marmot

Action on the social determinants of health (SDH) is required to reduce inequities in health. This article summarises global progress, largely in terms of commitments and strategies. It is clear that there is widespread support for a SDH approach across the world, from global political commitment to within country action. Inequities in the conditions in which people are born, live, work and age, are however driven by inequities in power, money and resources. Political, economic and resource distribution decisions made outside the health sector need to consider health as an outcome across the social distribution as opposed to a focus solely on increasing productivity. A health in all policies approach can go some way to ensure this consideration, and we present evidence that some countries are taking this approach, however given entrenched inequalities, there is some way to go. Measuring progress on the SDH globally will be key to future development of successful policies and implementation plans, enabling the identification and sharing of best practice. WHO work to align measures with the sustainable development goals will help to forward progress measurement.


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