Análisis
Medwave 2015 Oct;15(9):e6289 doi: 10.5867/medwave.2015.09.6289
El desafío de los sistemas de salud en el siglo XXI: ¿cómo incorporar el enfoque de los determinantes sociales de la salud?
The challenge for healthcare systems in the XXI century: how to incorporate the focus of social determinants in healthcare?
Cristóbal Cuadrado
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Palabras clave: social determinants of health, delivery of health care

Abstract

During the 20th century, a series of reflections on the role of biomedicine and social factors in the concept of health and disease processes served as a necessary prelude to the conceptual and empirical development of what later became known as the social determinants of health. In relation to this perspective, the question arises: What is the role of modern health systems from the perspective of the social determinants of health? This article presents an alternative view of the role of health systems from the focus of the social determinants of health, raising its importance and influence on the structural level, while addressing its implications as an intermediary determinant of health inequalities.


 

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During the 20th century, a series of reflections on the role of biomedicine and social factors in the concept of health and disease processes served as a necessary prelude to the conceptual and empirical development of what later became known as the social determinants of health. In relation to this perspective, the question arises: What is the role of modern health systems from the perspective of the social determinants of health? This article presents an alternative view of the role of health systems from the focus of the social determinants of health, raising its importance and influence on the structural level, while addressing its implications as an intermediary determinant of health inequalities.

Autor: Cristóbal Cuadrado[1]

Filiación:
[1] Programa de Políticas, Sistemas y Gestión en Salud, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile

E-mail: cristobalcuadrado@med.uchile.cl

Correspondencia a:
[1] Avenida Independencia 939
Santiago
Chile

Citación: Cuadrado C. The challenge for healthcare systems in the XXI century: how to incorporate the focus of social determinants in healthcare?. Medwave 2015 Oct;15(9):e6289 doi: 10.5867/medwave.2015.09.6289

Fecha de envío: 1/9/2015

Fecha de aceptación: 8/10/2015

Fecha de publicación: 20/10/2015

Origen: no solicitado

Tipo de revisión: con revisión por dos pares revisores externos, a doble ciego

Ficha PubMed

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  1. Wilson HJ. The myth of objectivity: is medicine moving towards a social constructivist medical paradigm? Fam Pract. 2000 Apr;17(2):203-9. | PubMed |
  2. Navarro V. Concepto actual de la salud pública. In: Martínez F, Antó JM, Castellanos P, Gili M, Marset P, Navarro V, editors. Salud Pública. Madrid: Mc Graw Hil; 1998: 49-54. | Link |
  3. Mackenbach JP. Politics is nothing but medicine at a larger scale: reflections on public health's biggest idea. J Epidemiol Community Health. 2009 Mar;63(3):181-4. | CrossRef | PubMed |
  4. McKeown T. Medical issues in historical demography. Int J Epidemiol. 2005 Jun;34(3):515-20. | PubMed |
  5. Szreter S. The Importance of Social Intervention in Britain’s Mortality Decline c. 1850-1914: a re-interpretation of the role of public health. Soc Hist Med. 1988;(1):1-23 | Link |
  6. Harris B. Public health, nutrition, and the decline of mortality: the McKeown thesis revisited. Soc Hist Med. 2004;17(3):379-407. | Link |
  7. Grundy E. Commentary: The McKeown debate: time for burial. Int J Epidemiol. 2005 Jun 34(3):529-33. | PubMed |
  8. Colgrove J. The McKeown thesis: a historical controversy and its enduring influence. Am J Public Health. 2002 May;92(5):725-9. | PubMed |
  9. Link BG, Phelan JC. McKeown and the idea that social conditions are fundamental causes of disease. Am J Public Health. 2002 May;92(5):730-2. | PubMed |
  10. McKinlay JB, McKinlay SM. The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century. Milbank Mem Fund Q Health Soc. 1977 Summer;55(3):405-28. | PubMed |
  11. Lalonde M. A new perspective on the health of canadians - A working document. Ottawa, Canada; 1974:1-77.
  12. Lalonde M. New perspective on the health of Canadians: 28 years later. Rev Panam Salud Publica. 2002 Sep;12(3):149-52. | PubMed |
  13. Gray AM. Inequalities in health. The Black Report: a summary and comment. Int J Health Serv. 1982;12(3):349-80. | PubMed |
  14. Marmot M. Social determinants of health inequalities. Lancet. 2005 Mar 19-25;365(9464):1099-104 | PubMed |
  15. Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, et al. The commission on social determinants of health: tackling the social roots of health inequities. PLoS Med. 2006 May;3(6):e106. | PubMed |
  16. Lee J, Sadana R. Improving equity in health by addressing social determinants [Internet]. Geneva: World Health Organization. Geneva: World Health Organization; 2011. | Link |
  17. Gilson L, Doherty J, Loewenson R, Francis V. Challenging inequity trought heath systems - final report. Knowledge network on health systems. 2007: 1-146. | Link |
  18. Commission on Social Determinants of Health. Closing the gap in a generation: health equity trough action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO; 2008:1-256. | Link |
  19. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Production. Geneva: WHO; 2010: 1-79. | Link |
  20. Frenz P, Vega J. Universal health coverage with equity : what we know, don’t know and need to know. accelerate universal health coverage. Montreux, Zwitzerland:WHO; 2010:1-56. | Link |
  21. Marmot M. Universal health coverage and social determinants of health. Lancet. 2013 Oct 12;382(9900):1227-8. | CrossRef | PubMed |
  22. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Health Policy Plan. 2014 Sep;29(6):717-31. | CrossRef | PubMed |
  23. Nye J. Soft power. Foreign Policy. 1990;80:153–71. | Link |
  24. Navarro V. What we mean by social determinants of health. Glob Health Promot. 2009 Mar;16(1):5-16. | CrossRef | PubMed |
  25. Gopinathan U, Cuadrado C, Watts N, Guinto RR, Hougendobler D, Wanjau W, et al. The political origins of health inequity: the perspective of the Youth Commission on Global Governance for Health. Lancet. 2014 Feb 15;383(9917):e12-3. | CrossRef | PubMed |
  26. World Health Organization. Declaration of Alma-Ata. Report of the International Conference on Primary Health Care. Geneva:WHO; 1978:1-77. | Link |
  27. Rasanathan K, Montesinos EV, Matheson D, Etienne C, Evans T. Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health. J Epidemiol Community Health. 2011 Aug;65(8):656-60. | CrossRef | PubMed |
  28. Maeseneer M, Willems S, De Sutter M, Van de Geucchte I, Billings M. Primary health care as a strategy for achieving equitable care: a literature review commissioned by the Health Systems Knowledge Network. 2007:1-42. [on line]. | Link |
  29. Law I, Widdows H. Health Care Anal. Conceptualising health: insights from the capability approach. 2008 Dec;16(4):303-14. | PubMed |
  30. Entwistle VA, Watt IS. Treating patients as persons: a capabilities approach to support delivery of person-centered care. Am J Bioeth. 2013;13(8):29-39. | CrossRef | PubMed |
Wilson HJ. The myth of objectivity: is medicine moving towards a social constructivist medical paradigm? Fam Pract. 2000 Apr;17(2):203-9. | PubMed |

Navarro V. Concepto actual de la salud pública. In: Martínez F, Antó JM, Castellanos P, Gili M, Marset P, Navarro V, editors. Salud Pública. Madrid: Mc Graw Hil; 1998: 49-54. | Link |

Mackenbach JP. Politics is nothing but medicine at a larger scale: reflections on public health's biggest idea. J Epidemiol Community Health. 2009 Mar;63(3):181-4. | CrossRef | PubMed |

McKeown T. Medical issues in historical demography. Int J Epidemiol. 2005 Jun;34(3):515-20. | PubMed |

Szreter S. The Importance of Social Intervention in Britain’s Mortality Decline c. 1850-1914: a re-interpretation of the role of public health. Soc Hist Med. 1988;(1):1-23 | Link |

Harris B. Public health, nutrition, and the decline of mortality: the McKeown thesis revisited. Soc Hist Med. 2004;17(3):379-407. | Link |

Grundy E. Commentary: The McKeown debate: time for burial. Int J Epidemiol. 2005 Jun 34(3):529-33. | PubMed |

Colgrove J. The McKeown thesis: a historical controversy and its enduring influence. Am J Public Health. 2002 May;92(5):725-9. | PubMed |

Link BG, Phelan JC. McKeown and the idea that social conditions are fundamental causes of disease. Am J Public Health. 2002 May;92(5):730-2. | PubMed |

McKinlay JB, McKinlay SM. The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century. Milbank Mem Fund Q Health Soc. 1977 Summer;55(3):405-28. | PubMed |

Lalonde M. A new perspective on the health of canadians - A working document. Ottawa, Canada; 1974:1-77.

Lalonde M. New perspective on the health of Canadians: 28 years later. Rev Panam Salud Publica. 2002 Sep;12(3):149-52. | PubMed |

Gray AM. Inequalities in health. The Black Report: a summary and comment. Int J Health Serv. 1982;12(3):349-80. | PubMed |

Marmot M. Social determinants of health inequalities. Lancet. 2005 Mar 19-25;365(9464):1099-104 | PubMed |

Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, et al. The commission on social determinants of health: tackling the social roots of health inequities. PLoS Med. 2006 May;3(6):e106. | PubMed |

Lee J, Sadana R. Improving equity in health by addressing social determinants [Internet]. Geneva: World Health Organization. Geneva: World Health Organization; 2011. | Link |

Gilson L, Doherty J, Loewenson R, Francis V. Challenging inequity trought heath systems - final report. Knowledge network on health systems. 2007: 1-146. | Link |

Commission on Social Determinants of Health. Closing the gap in a generation: health equity trough action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO; 2008:1-256. | Link |

Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Production. Geneva: WHO; 2010: 1-79. | Link |

Frenz P, Vega J. Universal health coverage with equity : what we know, don’t know and need to know. accelerate universal health coverage. Montreux, Zwitzerland:WHO; 2010:1-56. | Link |

Marmot M. Universal health coverage and social determinants of health. Lancet. 2013 Oct 12;382(9900):1227-8. | CrossRef | PubMed |

Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. Health Policy Plan. 2014 Sep;29(6):717-31. | CrossRef | PubMed |

Nye J. Soft power. Foreign Policy. 1990;80:153–71. | Link |

Navarro V. What we mean by social determinants of health. Glob Health Promot. 2009 Mar;16(1):5-16. | CrossRef | PubMed |

Gopinathan U, Cuadrado C, Watts N, Guinto RR, Hougendobler D, Wanjau W, et al. The political origins of health inequity: the perspective of the Youth Commission on Global Governance for Health. Lancet. 2014 Feb 15;383(9917):e12-3. | CrossRef | PubMed |

World Health Organization. Declaration of Alma-Ata. Report of the International Conference on Primary Health Care. Geneva:WHO; 1978:1-77. | Link |

Rasanathan K, Montesinos EV, Matheson D, Etienne C, Evans T. Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health. J Epidemiol Community Health. 2011 Aug;65(8):656-60. | CrossRef | PubMed |

Maeseneer M, Willems S, De Sutter M, Van de Geucchte I, Billings M. Primary health care as a strategy for achieving equitable care: a literature review commissioned by the Health Systems Knowledge Network. 2007:1-42. [on line]. | Link |

Law I, Widdows H. Health Care Anal. Conceptualising health: insights from the capability approach. 2008 Dec;16(4):303-14. | PubMed |

Entwistle VA, Watt IS. Treating patients as persons: a capabilities approach to support delivery of person-centered care. Am J Bioeth. 2013;13(8):29-39. | CrossRef | PubMed |