Written by: Steve Ouditt Updated: Jan, 2020 2 min read
Designers for health behaviour change should learn extensively about the Social Determinants of Health as it illustrates how much our health is shaped by people, places, things, services, organizations, systems, law and lawmakers. One of the best sources of information on the Social Determinants of Health is the World Health Organization – http://www.who.int/social_determinants/en/.
Here is how they define it, “The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”
Social determinants include: the food we eat; our levels of education; the quality of our family life; the nature of our jobs; how we get to and from work everyday; the communities we live in; the good and bad policies of the state and much more. In this social gradient of health, if we take a microscope to any of these areas we’d see people of all walks of life creating all sorts of systems and structures to make things fit nicely together. Take another microscope and we’d also see people failing to make things fit, or ‘make ends meet.’
Living inside this network of systems, it’s impossible to find a single factor that, if engineered well, will make everything work in perfect harmony. There is no perfect starting point for health improvement. This headache gets worse especially for those sliding down the social gradient in health. In short, experts define the social gradient in health as having a top and a bottom, where you can move up or down; something like a ladder propping against a wall but depending on the situation, the ladder might be raised higher or lowered somewhat flatter. Often it’s not one’s own choice to move up or down; this movement is shaped by the social determinants. At the top of the ladder are those, who, being in better socioeconomic standing will be in better health than those at the bottom, whose socioeconomic standing and health are both poor. The majority of the world’s population are trying to move up the social gradient of health.
That is our world. It’s stratified and unequal. Some people are born into wealth and some into poverty. Some are born into violence and some into peace. Some get breaks that make things work and some don’t. Some Governments care and some don’t. We never all start from the same place. Everyone in the world is subject to a unique set of social determinants to their health. Those of us who want to design behaviour change interventions must start by understanding this. At every turn in life we have to remind ourselves that there is a health information seeker, and a health care worker, living inside us all.
On page 3 of ‘The Health Gap: The Challenge of an Unequal World’, Sir Michael Marmot writes, “Were we going to tell the woman in Psychiatry Outpatients that she should stop smoking and, as soon as her husband stopped beating her, she should make sure that he and she had five fruit and vegetables a day?……. Were we going to tell the immigrant with a marginal, lonely existence to stop eating fish and chips and take out membership in a gym? ……….And for those who assert that health is a matter of personal responsibility, should we tell the depressed woman pull her socks up and sort herself out?”
Conscientious designers who work for better population health know these challenges. They know that they can’t simply apply design methods to design away these problems, nor would they be so insensitive and flippant as to think these problems can be solved with an ad campaign. Designers for health behaviour change are trained to expect such dire situations. That ‘s why their curriculum must be grounded on a solid programme of social justice. It is the pillar upon which design for health behaviour change should be built. If this is not the backbone of their programme and belief system, they will be found out early by the shallowness of their work and the institutions they attend. They will never be able to bluff it.
The photos in this blog post are book-covers from books in Vessel’s library. This post could not have been written without studying and comparing passages in these excellent texts.