Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

Abstract

BackgroundIn order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH) called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH) (e.g. social capital, empowerment, social inclusion). However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory.MethodsData were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted.ResultsStatistical analysis revealed that people on lower incomes (less than $45000) experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion), higher levels of discrimination and less political action (lower social inclusion) and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion) and engaging in more political action (higher social empowerment). In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion).ConclusionsApplying social quality theory allows researchers and policy makers to measure and respond to the multiple sources of oppression and advantage experienced by certain population groups, and to monitor the effectiveness of interventions over time.

“I can’t do this, it’s too much”: building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers

“…A related issue to consider here is socio-economic security which can determine access to and use of a range of resources that provide protection from poverty and other forms of material disadvantage (Ward, Meyer et al 2011). The lack of access for many Aboriginal Australians to the mainstream economy (Norris 2011) contributes to vulnerability and inequitable access to health care and other services that require (or are perceived to require) out of pocket payments.…”

“…Social inclusion is the extent to which people and groups have access to and are integrated into the different institutions (including hospitals) and social relations of "everyday life" and the extent to which people and groups "feel part of" or feel included in society at an everyday level (Commission of the European Communities 1993; Ward, Meyer et al 2011). Elements of disadvantage such as poverty, deprivation and structural violence have been shown to be important determinants of health and access to health services (Farmer 1997;Marmot 2003).…”

Analyzing Societal Circumstances, Sustainability and Sustainable Urban Development: New Theoretical and Methodological Challenges

“…This article argues that social quality theory's (SQT) conceptual framework has a universal tendency by nature and that the measures are commensurable as a condition for international application and comparison. The recent Asian and Australian work has, it is argued here, only changed practical aspects of the social quality indicators, in order to address specific aspects of their societies more expressively (Mitchell and Temple 2007;Oishi 2007;Bureekul 2007;Wang et al 2009;Yee and Chang 2009;Ward et al 2011;Lin 2011). However, according to Giri (2011), the social quality discourse (like the human security discourse) does not sufficiently reflect the profound rethinking of both "the social" and "the human" in current social theorizing.…”

Framing Social Inclusion as a Benchmark for Cycling-Inclusive Transport Policy in Kisumu, Kenya

“…While these individualised indicators offer a robust approach to assessing quality of life at the individual level, they are less useful when community and other social relations are the focus of analysis (Siltaniemi & Kauppinen, 2005). Moreover, the conventional quality of life paradigm presupposes the existence of certain social structures and relationships, thus precluding a critical analysis of how social structures and relationships relate with exclusion and wellbeing (Siltaniemi & Kauppinen, 2005;Ward, Meyer, Verity, Gill, & Luong, 2011). In contrast, social quality theory takes the premise that the individual is part of the larger society.…”