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"Social Determinants of Health - history"
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Appalachian epidemics : from smallpox to COVID-19
\"As the COVID-19 virus swept across the nation in spring 2020, infection and hospitalization rates in states like West Virginia remained relatively low. By that July, each of Appalachia's 423 counties had recorded confirmed cases. The coronavirus pandemic has taken an enormous toll on the health of individuals and institutions throughout the region-a stark reminder that even isolated rural populations are subject to historical, biological, ecological, and geographical factors that have continually created epidemics over the past millennia. In Appalachian Epidemics: From Smallpox to COVID-19, scholars from diverse disciplinary backgrounds assess two centuries of public health emergencies and their subsequent responses. This volume peers into the trans-Appalachian South's experience with illness, challenging the misconception that rurality provides protection against maladies. In addition to surveying the impact of influenza, polio, and Lyme disease outbreaks, Appalachian Epidemics addresses the less-understood social determinants of health. The effects of the opioid crisis and industrial coal mining complicate the definition of disease and illuminate avenues for responding to future public health threats. From the significance of regional stereotypes to the spread of misinformation and the impact of racism and poverty on public health policy, Appalachian Epidemics makes clear that many of the natural, political, and socioeconomic forces currently shaping the region's experiences with COVID-19 and other crises have historical antecedents\"-- Provided by publisher.
BOOK
Journal Voices in the Civil Rights Era — New Horizons and Limits in Medical Publishing
During the social tumult of the 1960s and 1970s, the
Journal
opened its pages to advocates of reform in the profession and society at large, but it did not completely break with its troubled racial past.
Journal Article
Then, Now, Next: Unpacking the Shifting Trajectory of Social Determinants of Health
This paper examines the evolving trajectory of the Social Determinants of Health (SDOH), tracing their development from early observational studies to contemporary, interdisciplinary frameworks that emphasize structural inequities and relational dynamics. It explores foundational milestones such as the Whitehall studies, the Heckler Report, and the World Health Organization’s conceptual models, which positioned SDOH as key drivers of population health. The paper highlights how upstream determinants—such as governance, policy, and socioeconomic systems—influence downstream health outcomes through mechanisms of social stratification and unequal access to resources. While SDOH are increasingly applied in clinical and educational settings, significant challenges persist, including underinvestment in community systems, fragmented care models, and political rollbacks of equity-centered policies. The paper critiques deterministic and deficit-focused framings of SDOH and underscores a shift toward more relational, context-sensitive, and agency-oriented approaches, reflected in the emerging concept of “social dynamics of health.” It highlights the importance of experiential education, competency-based curricula, and digital innovations in driving systemic transformation. Emphasis is placed on reimagining SDOH pedagogy and expanding interdisciplinary, data-driven research to bridge the gap between knowledge and practice. Amid shifting political landscapes, sustaining health equity efforts requires embracing adaptive, participatory models that acknowledge power, community agency, and structural change.
Journal Article
The First Community Health Center in Mississippi: Communities Empowering Themselves
The premise of a successful community health center is the active involvement with its target populations in ways that will change their knowledge, attitudes, and motivation-address the social, economic, environmental, and political circumstances that determine their ill health. To say these things and stop there is simple rhetoric. To act on them, to give them expression in new programs and new social institutions, to make them at once a part of the experience of the oppressed and the knowledge of the health professional student, requires more. Yet it can be done. The story of what began as the Tufts-Delta Health Center is a case in point.
Journal Article
Evoking Brecht’s A Worker’s Speech to a Doctor: developing clinical skills, deepening understanding and promoting action on living and working conditions, or mobilisation for system reform or transformation?
Bertolt Brecht’s 1938 poem ‘A Worker’s Speech to a Doctor’ has been used by health educators to direct attention to the health-threatening effects of adverse living and working conditions. However, to date there has not been a systematic analysis of these evocations and their goals (eg, develop clinical skills through promotion of empathy, encourage action to improve living and working conditions, and/or calls for broad societal mobilisation for systemic reform or even replacement). Of particular concern and relevance is the context in which this poem is mentioned, how it was applied, and whether it is presented in fragments or its entirety, thereby leaving intact Brecht’s critique of the capitalist economic system and its role in creating illness as well as the Doctor’s complicity in this same system. This investigation revealed that while most of the 56 instances found in books, book chapters, journal articles, presentations, and blogs did draw attention to how living and working conditions shape health and in many cases their public policy antecedents, most did not include the entire poem, leaving out Brecht’s critique and blunting his message. We suggest ‘A Worker’s Speech’ and other Brecht’s poems as a rich source for reflection, discussion, and action to promote health by health and social services workers, researchers, community activists, and the public.
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John D. Stoeckle and the Upstream Vision of Social Determinants in Public Health
Like others at Hull House, Hamilton was influenced by the socialism of Eugene V. Debs and the anarchism of Peter Kropotkin.14(pp237-239),15(pp62,86) At MGH, Ida Cannon organized the social work services under the direction of Richard Cabot, a senior physician concerned about the social conditions that affected health and illness.16 In her own work, Cannon acknowledged the inspiration that Jane Addams and Hull House had provided.17,18 Deeply influenced by Hamilton, Hardy, Cabot, and Cannon, as well as her successors, Stoeckle referred many times in his writings and in conversations to the importance of social work in clinical care and the intellectual and political roots of social work in Hull House and other settlement houses.19,20 In addition to social work, Stoeckle emphasized nursing,21,22 and anarchist strands entered there as well. Stoeckle often noted the key role that such nurses played in the settlement houses and early community health centers, and emphasized collaborative relationships with nurses in his teaching and writing.20-22 Stoeckle's innovative teaching and research using audiotaped and videotaped doctor-patient communication25 facilitated early empirical studies conducted in different primary care settings.
Journal Article
Cohort study of early literacy and childbearing over the reproductive lifecourse
IntroductionLiteracy is linked to a range of health outcomes, but its association with reproductive health in high-income countries is not well understood. We assessed the relationship between early-life literacy and childbearing across the reproductive lifecourse in the USA.Study designA prospective cohort design was employed to assess early-life literacy and subsequent childbearing, using data from the National Longitudinal Survey of Youth 1979. The US youth aged 14–22 years in 1979, including 6283 women, were surveyed annually through 1994 and biannually thereafter. Literacy was assessed in 1980 using the Armed Services Vocational Aptitude Battery Reading Grade Level (RGL). Cumulative childbearing and grand multiparity (≥5 births) were assessed in 2010. Summary statistics, χ2, Kruskal-Wallis, test for trend and logistic regression, were used.ResultsOf 6283 women enrolled, 4025 (64%) had complete data and were included in the analyses. In 1980, these women were on average 18 years old and in 2010 they were 45. Median cumulative parity decreased for each RGL and ranged from 3.0 (<5th grade) to 2.0 (>12th grade) (p=0.001). Adjusting for race/ethnicity, poverty status, whether a woman had had a child in 1980, and age in 1980, odds of grand multiparity were 1.9 (95% CI 1.1 to 3.5) and 1.8 (95% CI 1.0 to 3.3), greater among women with <5th or 5–6th grade literacy compared with those ≥12th literacy.DiscussionIn the USA, early-life literacy is associated with total parity over a woman's lifecourse. Literacy is a powerful social determinant of reproductive health in this high-income nation just as it has been shown to be in low-income nations.
Journal Article
Social determination of the health-disease process: a critical look from the epidemiology of the 21st century
The so-called social determination is a key concept for Latin American Social Medicine (LASM). LASM criticizes epidemiology frequently, mainly because of its reductionist vision and its distance from social reality. This paper makes an opposite analysis, in other words, 21st century epidemiology criticizes LASM, using the disciplinary development in Colombia as an example. The history of Colombian epidemiology is reviewed, noting that it has not had sufficient development and that LASM tends to reject quantitative methods based on the epidemiological practices used four decades ago. Additionally, some developments of the quantitative methods used in epidemiology are reviewed, explaining that many of the limitations indicated by LASM have been overcome. In conclusion, LASM uses social determination as part of its leftist political platform; however, current quantitative methods and the 21st century theoretical developments in epidemiology show a pragmatic superiority, useful for solving current public health issues.
Journal Article
Thinking about the social determination of the health-disease process
This article presents an epistemological discussion that underlies the proposal of social determination of the health-disease process, framing this discussion in the history of the current of thought known as Latin American Social Medicine, and analyzing the way in which this current approaches the study of health-disease processes in contemporary societies. To this end, a brief historical framework is elaborated, and the epistemological implications of the concept of social determination of the health-disease process are analyzed. Finally, three examples illustrate how the ideas about determination in the concrete study of reality are applied.
Journal Article
Preserving misconceptions or a call for action? - A hermeneutic re-reading of the Nativity story
Behaviour is guided by perceptions and traditions. As such, understanding culture and religion is important in order to understand healthcare behaviour. Religious perceptions shape a person's understanding of the world and are maintained through texts and tradition. One such important religious text in relation to sexual and reproductive health is the Nativity story. This account of the conception and birth of Jesus is well known in the Christian cultural sphere and beyond, and it has for generations shaped perceptions of childbirth.
This paper attempts a re-reading of the Nativity story using a hermeneutic approach.
This reveals a dual understanding of the Nativity, not just as an account of immaculate transcendence and a rosy Christmas tale, but as a source of identification for pregnant women and mothers and a call to action for improved maternal and child healthcare.
Journal Article