What We Mean by Social Determinants of Health
2009/07/01 by Vicente Navarro · 348 citations
Business, Management and Accounting · Medicine · #Alliance #Developing country #Development economics #Economic growth #Economics #Global Public Health Policies and Epidemiology #Global health #Globalization #Health care #Health promotion #Ideology #Inequality #Medicine #Neoliberalism (international relations) #Political economy #Political science #Politics #Power (physics) #Psychological intervention #Social determinants of health #Sociology #State (computer science)
paper · doi:10.2190/hs.39.3.a
published in International Journal of Health Services 39(3), 423-441 (SAGE Publishing)
openalex publication_date 2009/07/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
Abstract
This article analyzes the changes in health conditions and quality of life in the populations of developed and developing countries over the past 30 years, resulting from neoliberal policies developed by many governments and promoted by the World Bank, International Monetary Fund, World Health Organization, and other international agencies. It challenges interpretations by the analysts of "globalization", including the common assumption that states are disappearing. The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country, with establishment of an alliance between the dominant classes of developed and developing countries-a class alliance responsible for the promotion of its ideology, neoliberalism. This is the cause of the enormous health inequalities in the world today. The article concludes with a critical analysis of the WHO report on social determinants of health, applauding its analysis and many of its recommendations, but faulting it for ignoring the power relations that shape these social determinants. It is not inequalities that kill people, as the report states; it is those who are responsible for these inequalities that kill people.
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