REDET: THE BEST RESOURCE OF HEALTH PROMOTION FOUND IN 2003

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The best resource for my activities as consultant in Health Promotion (HP) in 2003 was the discovery of the Network on Social Determinants, REDET, coordinated by the University of Montreal in Canada. REDET is a multidisciplinary discussion group that is launching an initiative to promote debates about the study of social determinants of health, a most relevant subject in HP.

Reading a document of REDET translated by Mauricio Gomez-Zamudio to Spanish, opened to me a new perspective to promote the study of the determinants of health in Latin America and for incorporating in my work the different views that REDET is discussing. The reading was complemented by a video, also prepared by professor Gomez-Zamudio, that presents an “in vivo” debate among the group of Canadian experts from different disciplines who anchor the REDET. I found fascinating this opportunity to listen to each expert’s vision.

The REDET opens a new way to revisit and advance research on the social determinants of health. Their effort for extending the study to several countries in the Americas is crucial. In HP we always talk and emphasize the importance of the social health determinants but often, we do not go deep enough in their dimensions and their interrelationships. The materials of REDET precisely put the finger on these aspects. The participants in REDET call the attention to the importance of the weight of each determinant in specific social, economic, cultural and political contexts, which is very important.

The REDET group, in its basic documents, contends that four major conclusions can be drawn from the results of the last two decades of research .The first one, is a consensus about the influence of the physical, social, economic and cultural, environments on the health of populations. This is accepted by academics throughout the world as well as the fact that the environment affects differently the life of persons, families, and communities depending on a variety of circumstances. The second is the recognition of the existence of environmental and biological chains of factors that, again, act differentially according to the vulnerability of persons and groups. The third, based on economic research, points out that the socioeconomic categories are not intrinsically homogenous and that there is a big variability within each. The fourth is the fact that, all over the world, the States (governments) have been extremely constrained in their social investments during the last ten years and this fact has exacerbated the inequalities and inequities all over the world.

The REDET documents also present five models to analyze the social determinants in the context of the New Public Health, according to the types of variables considered. The first model is focused on social, collective and communitarian variables. In this model collective life is emphasized and the social relationships in each geographical location are singled out as important determinants of behaviors and life styles. This model is very much related to HP practice because of its focus on collective life.  In discussing this model, REDET, calls to attention the subject of structural violence as a cause of different types of problems in societies, which for me, is a priority for public health today.

The second model emphasizes the cultural dimension of behavior. The examples that the group of experts gives expose the intimate relationships between culture and disease and gives major importance to the study of culture as a basic element to understand the determinants of health. The third model considers the economic variables as main causes of the differences in the levels of health of populations and countries. Inside this model there are two main tendencies: the first emphasizes the gradient of social status categories whereas the second focuses more the inequalities due to poverty.

The fourth model is more controversial it has a political perspective and its proponents have a very critical position about analyzing the social determinants of health without a political ideology. The fifth and final model is called “ Ethical Perspective of Critical Public Health” and is focused mainly on a moral positioning of the public health workers. The authors describe this model as a post-modern tendency that should induce more debates among public health thinkers.

The initiative for the study of social determinants of health triggered by University of Montreal has already involved universities in Brazil, Costa Rica, Nicaragua and Peru. and in August 2004, a workshop will be held in Nicaragua.  I am sure that this extension of REDET as a Panamerican Network is going to be of great value to Latin America.

More information at: www.usi.umontreal.ca/redet  

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REFERENCES

REDET Módulo 1A: Fundamentos conceptuales; teorías de determinación social de la salud. Red de Formación.

REDET Módulo 1B: Movimientos sociales en salud. Universidad de Montreal, Canadá.

Video: Red sobre los determinantes sociales de la salud REDET. Mesa Redonda: Las cuatro caras de la salud y la enfermedad.