Adaptive Policies for Reducing Inequalities in the Social Determinants of Health

Abstract

Inequalities in the social determinants of health (SDH), which drive avoidable health disparities between different individuals or groups, is a major concern for a number of international organisations, including the World Health Organization (WHO). Despite this, the pathways to changing inequalities in the SDH remain elusive. The methodologies and concepts within system science are now viewed as important domains of knowledge, ideas and skills for tackling issues of inequality, which are increasingly understood as emergent properties of complex systems. In this paper, we introduce and expand the concept of adaptive policies to reduce inequalities in the distribution of the SDH. The concept of adaptive policy for health equity was developed through reviewing the literature on learning and adaptive policies. Using a series of illustrative examples from education and poverty alleviation, which have their basis in real world policies, we demonstrate how an adaptive policy approach is more suited to the management of the emergent properties of inequalities in the SDH than traditional policy approaches. This is because they are better placed to handle future uncertainties. Our intention is that these examples are illustrative, rather than prescriptive, and serve to create a conversation regarding appropriate adaptive policies for progressing policy action on the SDH.

Ten years on from the World Health Organization Commission of Social Determinants of Health: Progress or procrastination?

“…Despite the success of the South Australian HiAP model, it has not been adopted readily in other states and territories across Australia. Recent public health policy scholars have emphasised the importance of HiAP approaches, adaptive policies, intersectoral action and systems thinking to achieve action on SDH, but also questioned the extent to which current Australian approaches have been able to address structural health inequities . An over emphasis on individually focused, risk factor driven initiatives, has not helped in this regard .…”

A National Men’s Health Strategy in Australia: Tips for Implementation

“…Instead, turning our attention to emerging scholarship on action on policy development and social determinants of health is clearly required. 17,[20][21][22] Interestingly, this same focus has surfaced very prominently in health promotion and public health advocacy efforts in Australia, 23 with significant potential to learn from the Health in All Policies work spear-headed by the South Australian Government in partnership with the World Health Organisation. [24][25] It is strongly suggested that a minimum of six to eight cross-sectoral projects (e.g., health-employment; health-education; health-housing; health-justice partnerships) be identified as a starting point within the first three years of NHMS implementation to strengthen whole-of-government responses that address the social determinants of health.…”

Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

“…Similarly, Bruce et al [35] found affluent AAs in the Jackson Heart Study had a 41% lower prevalence of CKD than their less affluent counterparts. The World Health Organization acknowledges the inequities in social determinants of health and supports the potential of adaptive policies on general health aimed at improving education and reducing poverty [36]. …”