Hahn Robert A
Department of Anthropology, Emory University, Atlanta, GA.
J Public Health Res. 2021 Jun 23;10(4):2324. doi: 10.4081/jphr.2021.2324.
The objective of this essay is to clarify the understanding and use of Social Determinants of Health by exploring basic characteristics of 'determinants' and 'fundamental causes,' the 'social,' 'structure,' and 'modifiability,' and to consider theoretical and practical implications of this reconceptualization for public health. The analysis distinguishes SDOH from other determinants of health. Social determinants of health are defined as mutable societal systems, their components, and the social resources and hazards for health that societal systems control and distribute, allocate and withhold, and that, in turn, cause health consequences, including changes in the demographic distributions and trends of health. A systems conceptualization holds concepts such as "race" as the creations of social systems and as having negative consequences, such as racism, when part of a racist system, but potentially ameliorative consequences when part of an anti-racist system. The integration of SDOH into public health theory and practice may substantially expand the benefits of public health, but will require new theorizing, intervention research, education, collaboration, policy, and practice.
本文的目的是通过探讨“决定因素”和“根本原因”的基本特征、“社会”“结构”和“可改变性”，来阐明对健康的社会决定因素的理解和运用，并思考这种重新概念化对公共卫生的理论和实践意义。该分析将健康的社会决定因素与其他健康决定因素区分开来。健康的社会决定因素被定义为可变的社会系统、其组成部分，以及社会系统控制和分配、分配和保留的健康社会资源和危害，这些反过来又会导致健康后果，包括人口分布和健康趋势的变化。系统概念化认为，诸如“种族”之类的概念是社会系统的产物，当作为种族主义系统的一部分时会产生负面影响，如种族主义，但当作为反种族主义系统的一部分时可能会产生改善性后果。将健康的社会决定因素纳入公共卫生理论和实践可能会大幅扩大公共卫生的益处，但这需要新的理论构建、干预研究、教育、协作、政策和实践。
