[Pophealth] RWJ material on discussing social determinants of health

[Brodish, Paul]

I found this program interesting and was glad to know that nearly 2,000 people attended. Especially interesting is the fact that 95% of human thinking and emotion happens in the subconscious (and is thus subcortical, involving evolutionarily older parts of our brain).

One conflict I have is how to reconcile what was presented with the concept of political struggle for human rights/justice, which involves (requires?) constant conflict/tension versus a "mutual understanding" and language "resonation" that this "messaging" (I did not know message was a verb) effort seems to seek. Who is the "we" when "we" work together for health? What does "solidarity" mean in a cognitive conceptual realm like "social or societal determinants of health?"

According to Vicente Navarro [AJPH, 100(3), p.401, discussing the recent US health care reform]: "We have plenty of experience (with anti-poverty and other means-tested programs) to show that compassion is not a good motivator. Solidarity (I take care of you on the condition that you take care of me) is a much better motivator." This statement evokes the notion of noblesse oblige, or the obligation of the well-off to take care of the less well-off, something as foreign as it sounds in a country which does not openly acknowledge class (maybe, from the right-wing perspective "trickle down" is supposed to do this here?). It suggests there are obligations on both sides (a sort of enforceable contractual arrangement?). It also evokes Lech Walesa and the early 1980's Solidarity movement. If there is no state to enforce these obligations (or a "state of indifference" toward them), then should enforcement not arise from below, from the oppressed?


-----Original Message-----
From: Stephen Bezruchka [mailto:sabez at u.washington.edu] 
Sent: Saturday, July 31, 2010 1:14 PM
To: Population Health Forum
Subject: [Pophealth] RWJ material on discussing social determinants of health

On Thursday there was a web-based program on disucssing the "social  
determinants of health" put on by the Robert Wood Johnson Foundation.   
I put quotes around SDOH because I'm not fond of the phrase and  
watching this gave me another reason not to use it in discussions with  
most people.  I prefer to speak of societal determinants but that is  
little used and likely no better.

The session is archived in 3 formats at
http://www.rwjf.org/pr/product.jsp?id=66428

with a pdf messaging guide, the slides and a recording of the slides  
merged with audio, realtime.

Let me suggest you look at the pdf messaging guide.  Page 6 has a key  
message they found that tested well in their research and suggest  
reasons why.  Page 28 and beyond gives more material on how they came  
to that statement. These ideas may be useful for our effortts to draw  
attention to the mortal facts of living in the USA.

Other good material "Nine Facts about Facts" is on page 10-11.

The Appendices describe how they arrived at these ideas.

These ideas were developed by plenty of qualitative research and  
message design used by marketers to get us to buy stuff.  Given our  
huge levels of consumption per capita in comparison to the rest of the  
world the techniques clearly work to sell products.  Huge sums of  
money are spent in designing advertising to convince us to buy just  
about anything sold.  Will similar techniques work to improve our  
health?  Who knows?  Much of what I present to students in courses is  
based on a variety of ways and sources.  Learning occurs over an  
academic quarter.  But spreading those concepts to others in brief  
encouters is more difficult.  I think we would all benefit from  
looking at these materials.

That said, there is very little about inequality, nor much about  
income and nothing about the need for reducing the huge income gap in  
the US or on tax policies.  So this material represents a very  
sanitized way of siding up to key structural or political factors in  
the US that lead to early death.  (already that statement would not  
fly with RWJ's market research)  But our challenge is to find better  
ways of talking about population health (not a single occurrence of  
that phrase in the materials) so there may be some good ideas we can  
glean from their work.

There is an earlier publication from RWJ on message translation that  
isn't as clearly focused as these issues, but may be helpful.
Commission to Build a Healthier America (2009). Breaking Through on  
the Social Determinants of Health and Health Disparities:  An approach  
to message translation. Princeton NJ, Robert Wood Johnston Foundation.  
available at:
http://www.rwjf.org/files/research/commissionmessagetranslationissuebrief20091207.pdf

For political progressives these communication materials will seem  
insipid.  If we have opportunities to speak to mainstream groups we  
may get asked back if we can craft appropriate language to use with  
them to begin working together for health.

Please share any thoughts you have with the Forum.

Stephen