Commissioning and social determinants: evidence and opportunities

Author(s):  
Chris O’Leary ◽  
Chris Fox

This chapter argues that local authorities can and should use their purchasing power strategically to address the social determinants of health that affect their local area. It examines commissioning and procurement as local authority functions, defining these concepts and exploring the conceptual confusion between the two. The chapter then looks at the evidence of current practice of local authorities (with a particular focus on local authorities in the UK) in strategic use of their purchasing power. Core to the argument is the role of local voluntary organisations and small and medium-sized enterprises (SMEs), so there is a particular focus on the commissioning experience of these types of organisations. Finally, the chapter makes the case for the role that voluntary sector organisations can play in addressing social determinants of health, before drawing some broad conclusions about the way forward.

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract While the political and social determinants of health have become accepted among academic researchers, health inequalities in the health policy and political arenas are still predominantly addressed as outcomes of citizens' lifestyle and behavioural choices. The rise of populist radical parties across Western countries brings renewed urgency to communicating with elected leaders and policy makers about the importance of tackling the social (as well as behavioral and medical) determinants of health. Recent publications such as 'Health in Hard Times. Austerity and Health Inequalities' (Clare Bambra, 2019) and 'Health Equity in England: The Marmot Review 10 Years On' (Marmot et al, 2020) find that financial and economic policies in large part contribute to stagnating and even reversing population health trends in the UK and across Western countries. The underlying political system of decision-making needs to be clarified in order to effectively engage and exert influence. This workshop aims to strengthen countervailing power and competence in understanding the policy trajectories that effectively target the larger ambitions of economic and social welfare including reduced health inequalities. We provide participants with basic knowledge, methods and tools to carry out practice-based comparative analysis of public health politics and policies across different countries. The workshop consists of: A 20-minute mini-lecture by Julia Lynch, who will present key findings and the underlying methodology of her recent book Regimes of inequality: The political economy of health and wealth. This book systematically used historical institutionalist-methods and process tracing to compare the policies and politics aimed at reducing health inequalities in Finland, France and the UK from the 1990s to the present.A 15-minute panel reflection: The panel, consisting of Clare Bambra, Karien Stronks, and Holly Jarman, will relate this to their own key research and impact.A 25-minute plenary discussion of examples, questions and contributions to tackling inequalities in political and social determinants of health. Examples are labour market participation policies, progressive fiscal policies or policies resolving illiteracy or household financial debt. Key messages Health inequalities are a political choice. Learning by comparison increases capacity to improve policies on the social determinants of health as well as capacity to increase political influence.


2017 ◽  
Vol 8 (2) ◽  
pp. e87-89
Author(s):  
Russell Eric Dawe

Indira is an independent woman who does not live a traditional Nepali life. She rescues abandoned and abused young women from sexual exploitation and provides them with love, support, and education. Her story highlights the key role of the social determinants of health in caring for marginalized populations. Challenges and benefits of attempting to learn from another’s personal narrative are also considered.


Author(s):  
Juliet Iwelunmor ◽  
Collins Airhihenbuwa

We provide an overview on the role of culture in addressing the social determinants of health and risk. The fact that everyone is influenced by a set of locally defined forms of behavior means that while not overtly expressed, culture’s effects can be ubiquitous, influencing everything including the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping health and risk messaging. While the dynamic nature of culture is underestimated and often not reflected in most research, efforts to close the gap on social determinants of health and risk will require greater clarity on what culture is and how it impacts culture-sensitive health communication. Thus, the paper begins by reviewing why culture is so vital and relevant to any attempts to improve health and reduce health inequalities. We discuss what is meant by the term “culture” through a narrative synthesis of historical and recent progress in definitions of culture. We conclude by describing three distinct cultural frameworks for health that illustrate how culture can be effectively used as a vehicle through which to address culturally sensitive health communication in local and global contexts. Overall, we believe that culture is indispensable and important for addressing inequalities and inequities in health as well as for facilitating culture-sensitive health communication strategies that will ultimately close the gap on the social determinants of health and risk.


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