The Structural Determinants of Health: A Deep Dive into Public Health’s Future

by Jon Scaccia March 18, 2024

In the transformative article, Keeping It Political and Powerful: Defining the Structural Determinants of Health, the authors Jonathan C. Heller, Marjory L. Givens, Sheri P. Johnson, and David A. Kindig offer a comprehensive and thought-provoking exploration of the structural determinants of health. Their work delves deeply into the intricate web of societal norms, policies, and power dynamics that shape our health outcomes.

Understanding the Structural Determinants of Health

At the core of the article is a nuanced definition of structural determinants of health. These determinants are not just about individual choices or behaviors, but about the broader societal rules and power relations that create patterns of advantage and disadvantage.

The Interplay of Power and Health

Power, as defined in this context, is the force that establishes and upholds the societal rules that ultimately dictate patterns of advantage and disadvantage within our communities​​.

The Essence of Power in Public Health

The concept of power is fundamental to understanding the structural determinants of health. It’s not just about who has power but how it’s used to enforce the societal norms and policies that either promote health equity or exacerbate health disparities. Crucially, the shifting of power dynamics is required to effect meaningful changes in these determinants. This shift is not just a theoretical concept but a practical approach to dismantling the enduring patterns of inequality that plague our health systems.

Tangential Note: I’m a big fan of thinking about how power, especially in data, can speak to social change and raise up the voices of those who have traditionally been stripped of that power. The book Data Feminism by D’Iganzio and Klein has been particularly transformative in my own thinking.

Structural Interventions: A Tool for Change

Structural interventions, as discussed in the article, are mechanisms that can empower those marginalized by systemic oppression. These interventions aim to redistribute power, making it a potent tool for public health practitioners. They go beyond mere improvements in daily living conditions (a focus on social determinants of health) and address the underlying social processes and power imbalances that lead to inequitable resource distribution.

The Complexity of Interventions

It’s essential to distinguish between interventions targeting social determinants of health (SDOH) and those aiming at structural determinants. While policies improving daily life conditions (like enhancing neighborhood environments) fall under SDOH, they may not necessarily address the deeper structural issues. Existing governance ideologies, fiscal policies, institutional practices, and cultural norms often mediate the impact of such policies. In contrast, interventions targeting structural determinants look to change these underlying factors, thereby having a more profound and lasting impact on health equity.

The Role of Public Health Practitioners

For public health professionals, this article is a call to action. It emphasizes the need for a shift from traditional health interventions to strategies that address these structural determinants. This involves advocating for policy changes and engaging in political processes to reshape power dynamics that perpetuate health inequities.

Advancing Health Equity

The article is not just an academic exploration; it provides a practical framework for advancing health equity. By understanding and intervening in the structural determinants of health, public health practitioners can play a pivotal role in creating a more equitable society where health disparities are significantly reduced.

Conclusion: A New Direction for Public Health

This article challenges us to think differently about health equity and the actions required to achieve it. As a public health practitioner or enthusiast, reading this article is not just informative but potentially transformative. It encourages us to think beyond the conventional and to embrace a more holistic, politically engaged approach to public health.

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