[Pophealth] RWJ material on discussing social determinants of health

[donrimmer at comcast.net]

I understand Paul's struggle with the forum report. In the interest of brevity, I will merely offer that the RWJ Foundation study suggests an alternative methodology to reduce conflict and tension, ostensibly based on the notion that conflict has produced less than desirable outcomes, at least in recent decades. To review this work, with any seriousness, requires an acceptance of that premise--albeit temporarily. There still, however, remains the discussion as to whether the RWJ prescription is palliative or not. 



Personally, I see some useful information residing in the study. The bigger message seems that the general public is ill-equipped to deal with the language coming from professionals. Judging by the content of recent commercials (designed for a similar audience) it’s not that surprising. Use the term Societal Determinants of Health in a casual group conversation and you soon realize it leaves most people bewildered. That’s not to say that term lost its utility amongst the drivers of the movement. However, in order to convey concepts to a larger audience, we need to select terms carefully. 



Given the current financial influence of over the government, policy change has become more challenging. In light of that, information relating to terms that influence policy makers deserves some attention. 



Yet another aspect of the report that offers some practicality is the reference to Republican objection to terms like equity or equality. We are so far from "equity," that we can afford to avoid such terms and still make strides toward significant improvement. 



At the last meeting, we spent considerable time evaluating the web site and discussing possible changes. This report also provides information that can benefit site revisions, should that be undertaken. 

If you are inclined to believe that we need to connect with a greater audience and be more effective at influencing policy, this report has some useful information. As was pointed out in the beginning, we just need to search for those pieces that benefit us. 

Cheers, 

Don 



----- Original Message ----- 
From: "Paul Brodish" <brodish at unc.edu> 
To: "Stephen Bezruchka" <sabez at u.washington.edu>, "Population Health Forum" <pophealth at u.washington.edu> 
Sent: Monday, August 2, 2010 8:54:19 AM 
Subject: RE: [Pophealth] RWJ material on discussing social determinants of health 

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 


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