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December 12, 2008

On the Social Determinants of Health, the NIH, and Translation

Translation is a hot-button word in public health and research policy these days.  This is welcome, because one of the principal themes of this blog has been that even if we ceased all technical innovation in health, we have all the evidence and interventions we need to make our (U.S. and global) population substantially healthier than it is.  This is not to endorse the cessation of innovation, but to note that the link between improved population health and translation of the evidence we already possess, in my opinion, rests on much firmer footing than does the link between population health and increased innovation.

Thus, as always, the policy arguments I suggest are focused on notions of relative priority.  One of the primary criticisms of research and scholarship on the social determinants of health is that much of the evidence is just that, and that SDOH scholars and stakeholders often are focused on documenting the evidence rather than working to translate that evidence into policy and practice.  (As an aside, one can also see the specter of the naturalistic fallacy lurking here, in which too many stakeholders simply presume that the evidence itself justifies normative commitments, which is dubious).  To that end, I was pleased to watch the live Videocast of a talk given by Sir Michael Marmot, one of the most important social epidemiologists in the world and the Chair of the WHO Commission on the Social Determinants of Health.  The talk is (aptly) entitled, "Social Determinants of Health: From Research to Action."

He is a gifted speaker, and both his passion and his erudition shine through in the talk.  He had been invited to speak to the NIH Directors in a closed-door meeting held yesterday, Dec.11, 2008, followed by the public talk.  The NIH Videocast service, which is a wonderful resource, has quickly archived Marmot's talk, which you can access here (RealPlayer required).

There is simply too much incredible information from the talk to encapsulate here in a blog post, but one thing I was struck by is Marmot's insistence on and commitment to strategies and means of implementing the robust SDOH evidence base.  At various times in the talk, Marmot evinces both great pessimism and sunny optimism as to the state of the political will needed to incorporate the SDOH into public health policy.  In my mind, what is most needed is a fundamental reconceptualization of what we deem to be public health policy, such that social policies like housing, occupation, and environment are all expressly and directly deemed to be public health policy, and are implemented as such.

Sadly, for many reasons, I do not share some of Marmot's optimism, especially not in the U.S.  But, as the humanists themselves epitomized, there are some fights worth fighting even if you know you are going to lose.



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well this debates end no where.

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