Download as PDF, PPTX
![“In total, across England as a whole,
the WCA disability reassessment
process during this period [2010-13]
was associated with an additional
590 suicides (95% CI 220 to 950),
279,000 additional cases of self-
reported mental health problems
(95% CI 57,000 to 500 000) and the
prescribing of an additional 725 000
antidepressant items (95% CI
406,000 to 1,045,000).”
Barr B, et al. ‘First, do no harm’: are disability
assessments associated with adverse trends in
mental health? A longitudinal ecological study J
Epidemiol Community Health 2015;0:1–7. doi:
10.1136/jech-2015-206209
that Government policy causes suicide](https://image.slidesharecdn.com/412howtoheadupstream-180308161739/75/Reconstructing-the-social-determinants-of-health-6-2048.jpg)
![“These findings [better long-term outcomes for schizophrenia
in developing countries] still generate some professional
contention and disbelief, as they challenge outdated
assumptions that generally people do not recover from
schizophrenia and that outcomes for western treatments and
rehabilitation must be superior. However, these results have
proven to be remarkably robust, on the basis of international
replications and 15-25 year follow-up studies. Explanations for
this phenomenon are still at the hypothesis level, but include: (1)
greater inclusion or retained social integration in the community
in developing countries, so that the person retains a role or status
in the society (2) involvement in traditional healing rituals,
reaffirming community inclusion and solidarity (3) availability of a
valued work role that can be adapted to a lower level of
functioning (4) availability of an extended kinship or communal
network, so that family tension and burden are diffused, and
there is often less negatively 'expressed emotion' in the family”
Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed
Countries learn from Developing Countries? World Psychiatry 2006, 5: 21-24
that recovery rates are better where there
are fewer mental health services](https://image.slidesharecdn.com/412howtoheadupstream-180308161739/75/Reconstructing-the-social-determinants-of-health-7-2048.jpg)
![Public health narratives, even when they acknowledge the
importance of other factors, still tend to be framed within a
medical-biological narrative that leaves those factors
poorly defined…
Health = Body (genes) + Environment (bugs) + Behaviour (dumb stuff people do)
[some mysterious social stuff we leave to politicians, social workers et al.]
Doctors &
Nurses
Public
Health
Health
Promotion
+ X](https://image.slidesharecdn.com/412howtoheadupstream-180308161739/75/Reconstructing-the-social-determinants-of-health-10-2048.jpg)
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Reconstructing the social determinants of health
Dr. Simon Duffy discusses the critical importance of addressing social determinants of health, particularly poverty and inequality, which are often sidelined due to political complexities. The document emphasizes that public health leaders must reframe their approach to engage in meaningful dialogue and solutions, highlighting that issues like mental health and obesity are linked to economic policies and societal values. It calls for a collective reassessment of strategies to tackle these fundamental issues that affect health outcomes in communities.
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Similar to Reconstructing the social determinants of health
Reconstructing the social determinants of health
- 1. Reconstructing the socialdeterminants of health Thoughts on strategy for Directors of Public Health by Dr Simon Duffy of the Centre for Welfare Reform
- 2. • Social determinantsof health are critical, but we constantly avoid addressing them • Taking poverty as a case study, we can see that the reason is not their ‘technical’ difficulty • It is the ‘politics’ of the issue that makes what is most important the most difficult to address • Public health leaders will need to reframe their concerns in ways that enable potential solutions to emerge • Is there a way of describing social determinants that is political engaging and avoids ideological dead zones?
- 3. You all knowthat healthcare is not the most important factor in promoting health Image courtesy of David Buck, The King’s Fund
- 4. You all knowthat healthcare can be problematic or ineffective
- 5. Black men inBritain are 5 times more likely to be in prison and 17 times more likely to be diagnosed with a psychotic illness. that prejudice and racism cause mental illness
- 6. “In total, acrossEngland as a whole, the WCA disability reassessment process during this period [2010-13] was associated with an additional 590 suicides (95% CI 220 to 950), 279,000 additional cases of self- reported mental health problems (95% CI 57,000 to 500 000) and the prescribing of an additional 725 000 antidepressant items (95% CI 406,000 to 1,045,000).” Barr B, et al. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study J Epidemiol Community Health 2015;0:1–7. doi: 10.1136/jech-2015-206209 that Government policy causes suicide
- 7. “These findings [betterlong-term outcomes for schizophrenia in developing countries] still generate some professional contention and disbelief, as they challenge outdated assumptions that generally people do not recover from schizophrenia and that outcomes for western treatments and rehabilitation must be superior. However, these results have proven to be remarkably robust, on the basis of international replications and 15-25 year follow-up studies. Explanations for this phenomenon are still at the hypothesis level, but include: (1) greater inclusion or retained social integration in the community in developing countries, so that the person retains a role or status in the society (2) involvement in traditional healing rituals, reaffirming community inclusion and solidarity (3) availability of a valued work role that can be adapted to a lower level of functioning (4) availability of an extended kinship or communal network, so that family tension and burden are diffused, and there is often less negatively 'expressed emotion' in the family” Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries learn from Developing Countries? World Psychiatry 2006, 5: 21-24 that recovery rates are better where there are fewer mental health services
- 8. that income inequalitycauses mental illness
- 9. Equality Trust Data andmany, many other problems
- 10. Public health narratives,even when they acknowledge the importance of other factors, still tend to be framed within a medical-biological narrative that leaves those factors poorly defined… Health = Body (genes) + Environment (bugs) + Behaviour (dumb stuff people do) [some mysterious social stuff we leave to politicians, social workers et al.] Doctors & Nurses Public Health Health Promotion + X
- 11. The particular dangerfor leaders in public health is that they can become complicit in prioritising the wrong factors… Bob Holman: "This is not rocket science. Poor health is a well-known feature of deprivation. Mothers are not daft and they do know fat and crisps are bad for children but they can't afford the alternative. The Government has to give them the means. Initiatives are not going to change anything unless you've got the cash in your pocket. If you buy a salad at Sainsbury's, it's still very expensive." from Childhood obesity: a plan for action: “The burden is falling hardest on those children from low-income backgrounds. Obesity rates are highest for children from the most deprived areas and this is getting worse. Children aged 5 and from the poorest income groups are twice as likely to be obese compared to their most well off counterparts and by age 11 they are three times as likely. “Obesity is a complex problem with many drivers, including our behaviour, environment, genetics and culture. However, at its root obesity is caused by an energy imbalance: taking in more energy through food than we use through activity. Physical activity is associated with numerous health benefits for children, such as muscle and bone strength, health and fitness, improved quality of sleep and maintenance of a healthy weight. There is also evidence that physical activity and participating in organised sports and after school clubs is linked to improved academic performance.” The Government’s obesity plan does not include one single measure to reduce poverty.
- 12. We’re all againstinequality, but…
- 13. In fact povertyand inequality are much less complex than disease or mental health. Most of the factors which shape it are direct or indirect results of Government economic policy and the welfare state.
- 14. Over the last40 years economic change has only increased the incomes of the top 15%.
- 15. Over the last40 years redistribution has been about subsidising the incomes of the middle-income groups - at the expense of the rich - and the poor!
- 16. We’ve been persuaded- despite all the contrary evidence - that inequality is good for the economy - and so we need it to pay for the welfare state - perhaps by the same logic that doctors need illness…
- 18. It’s worth reflectingon the tendency to externalise income inequality to the private sector, although the NHS has high salaries and even higher income inequalities - ie. it’s a socio-economic polluter
- 20. How did weget here?
- 21. 1. Who ismaking decisions on whose behalf? 2. Who sets the agenda and decides what decisions need to be made? 3. Whose ideas dominate thinking about what’s important? If poverty and inequality is a function of government policy then we must examine the nature of power
- 22. • Democracy -electoral system, corrupt second chamber, lack of constitutional checks and balances, lack of adequate protection for basic human rights, hyper-centralisation etc. • Civil society - weak trade unions, charities stifled by legal constraints and contracts, lack of representation of the poorest, corporate influence, jobs for politicians, funding for think tanks, media controlled by the wealthy etc. • Ideology - lies and myths about poverty, extreme economic liberalism (devil-take-the hindmost), meritocracy (we only need the best) new eugenic thinking (it’s all the parent’s fault) etc. Explanatory factors are various and perhaps hard to weight, but hardly mysterious, and include the following
- 23. Case study incorruption: WCA/ESA policy was driven by ideology, false assumptions about dependency and the “bio-psycho-social” model of disability - influence of US insurers - accelerated by Coalition’s austerity policy - which was itself a response to financial crisis caused by overinflated mortgage market - misleading press releases from DWP - media eager to promote ‘scrounger’ rhetoric - lies becomes fact - advertising on a Sheffield street - another reason for self-loathing - increased disability hate crime - increased suicide
- 24. Model developed todescribe relatively poor health outcomes in Scotland - The Thatcher Effect
- 25. High-earning migrants andpromising student entrepreneurs will find it easier to work in Britain as the coalition aims to ensure only “the right people are coming here”, the Immigration Minister has said. Damian Green, a Conservative MP, said middle managers, unskilled labourers and benefit seekers would be kept out as the coalition seeks only migrants who “add to the quality of life in Britain.” (from The Scotsman) Government ministers are now happy to denigrate and blame ordinary citizens - elitism dressed as meritocracy
- 26. Austerity is acase study in politics of economic system - social care is cut because local government is blamed
- 28. …there is reliableevidence that the threshold of grave or systematic violations of the rights of persons with disabilities has been met in the State party… The core elements of the rights to independent living and being included in the community, an adequate standard of living and social protection and their right to employment have been affected… freedom of choice and control over their daily activities restricted, the extra cost of disability has been set aside and income protection has been curtailed as a result of benefit cuts, while the expected policy goal of achieving decent and stable employment is far from being attained UN Committee on the Rights of Persons with Disabilities: Inquiry concerning the United Kingdom of Great Britain and Northern Ireland carried out by the Committee under article 6 of the Optional Protocol to the Convention 6th October 2016 UN declares UK Government fails to respect disability rights
- 30. What can wedo?
- 31. We need tofind ways to honestly address the real issues Reframing with a purpose: We can begin by describing our problems and possible solutions in ways that make sense to allies and partners.
- 32. 1. Find a hopefulway to describe the challenge ahead
- 34. For me, treatingequal citizenship as the goal is helpful - not only because it’s powerful and appealing - but also because it treats all of us as both the resource and as the duty- holder - we have the means and obligation to solve our own problems.
- 37. 2. Seek out energyand resources that can be reused
- 38. Notice that thisanalysis helps Barnsley identify both its own capacity for change and also locates the externally imposed injustices in the right place - truth and justice are both essential.
- 39. 3. Define a feasibleend- state that people can seek together
- 40. This analysis demonstratesclearly that poverty and inequality is not only unnatural it is clearly in our scope to manage - if we are prepared to honestly examine the goal.
- 41. Facts are helpfuland often surprising - e.g. benefit spending is barely progressive and already near universal
- 44. 4. Imagine real world solutionsthat are politically sustainable
- 46. 5. Question assumptions that lock peopleinto bad policies
- 50. 6. Respect the effortsof leaders and community action
- 56.
- 57. If salary ratioswithin the public sector influence overall inequality then the public sector has a strong imperative to control its own inequalities.
- 59. 8. Structure policy around sharedvalues to encourage new alliances
- 60. 1. Environment -living in a clean, healthy and sustainable world 2. Economics - having financial security and a fair share 3. Community - being part of a flourishing and democratic place 4. Family & social life - being with people you care about 5. Citizenship - developing your talents and playing a positive role Here is a way of reframing the territory for improving public health in different terms. This not the only way of slicing the available territory, rather it reflects my ongoing concerns and interests… = = The Social Determinants of Health
- 61. In your localcommunity what is the best way to define the challenge to engage others? How do we talk about social justice and fairness? How could we transform our natural environment? How would you engage citizens in ways that promoted agency? What are the conditions necessary to promote vibrant and inclusive community development? Who are your real allies? What is the pattern of transformation for local government itself?
- 62.