Doctoral Students
Brad Crammond PhD due for completion by Mar 2013
Thesis topic: Social epidemiology, inequalities in health and justice
Social epidemiology has emerged in the last five years as the dominant discipline on equity in health. With the comprehensive work of the WHO Commission on Social Determinants of Health culminating in the well-received and much discussed report Closing the Gap in a Generation, social epidemiology has outlined a programme of social justice based upon health improvement. In early 2012 the work of the CSDH was transformed into an international declaration signed by heads of state across the world. The Rio Political Declaration on Social Determinants of Health is set to join documents like the Ottawa Charter on Health Promotion and the Alma Ata Declaration on Primary Health Care as the pre-eminent statements of priorities in health promotion, practice and research.
In achieving this priority it might be assumed that social epidemiology (the research arm of social determinants of health) impartially represents the state of inequalities in health and proposes an objective, scientific response to health inequity worldwide. Such an assumption misrepresents the complex nature of the relationship between social status and health outcomes and the interpretation required to translate epidemiological evidence into policy options. At the same time it ignores that the method of measuring the problem helps to shape the understanding of the problem.
From the perspective of social justice, the most problematic aspect of the social epidemiological discipline is its conflation of reducing health disparities with social justice. Though health disparities are associated with disparities in income, education, occupation and so on, it does not follow that (a) reduction of one will result in reduction of the other or (b) the type of reduction called for by social epidemiology is the type which is most conducive to social justice overall. In short, constructing an education system to reduce health inequality is not necessarily the most appropriate way to promote educational justice (which is valued independently of its effect on health). The health reductionism practiced by the social determinants of health movement therefore mistakes reducing health inequalities for a complete model of social justice, in the process dismissing two millennia of political philosophy.
The aim of this project is to reconceptualise social epidemiology and social determinants of health research and policy so as to make it an element of, rather than a proxy for, social justice. In doing so the project examines,
1. Weaknesses in the existing discipline, particularly its reinforcement of certain inequitable structures like wage labour and corrupt government.
2. The tendency of existing models of health justice to perpetuate these errors.
3. The historical reasons for the persisting disjuncture between social and health policy.
A model will be proposed for resolving these difficulties.