Journal of Public Health | Vol. 36, No. 3, pp. 353 – 354 | doi:10.1093/pubmed/fdu070
Editorial Looking upstream for influences on socioeconomic inequalities in health
Ted Schrecker, Eugene Milne
References 1 Rydin Y, Bleahu A, Davies M et al. Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet 2012;379:2079 – 108. 2 Diderichsen F, Evans T, Whitehead M. The social basis of disparities in health. In: Whitehead M, Evans T, Diderichsen F, Bhuiya A, Wirth M (eds). Challenging Inequities in Health: From Ethics to Action. New York: Oxford University Press, pp. 2001, 13– 23. 3 Kwarteng JL, Schulz AJ, Mentz GB et al. Associations between observed neighborhood characteristics and physical activity: findings from a multiethnic urban community. J Public Health 2014;36:358– 67. 4 Slater T. Your life chances affect where you live: a critique of the ‘cottage industry’ of neighbourhood effects research. Int J Urban Reg Res 2013;37:367– 87. 5 Bambra C, Barr B, Milne E. North and South: addressing the English health divide. J Public Health 2014;36:183 – 6. 6 Copeland A, Kasim A, Bambra C. Grim up North or Northern grit? Recessions and the English spatial health divide (1991 – 2010). J Public Health 2014. doi:10.1093/pubmed/fdu019. 7 Stuckler D, Basu S. The Body Economic: Why Austerity Kills. London: Allen Lane, 2013. 8 Beatty C, Fothergill S. Hitting the Poorest Places Hardest: The Local and Regional Impact of Welfare Reform. Sheffield: Centre for Regional Economic and Social Research, Sheffield Hallam University, 2013. http://www.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/ hitting-poorest-places-hardest_0.pdf (date last accessed 14 August 2014).
# The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected].
353
Downloaded from http://jpubhealth.oxfordjournals.org/ at Universite Laval on July 7, 2015
The authors of a recent article on health and urban planning1 observed that ‘[r]ich and poor people live in very different epidemiological worlds, even within the same city’. The authors did not elaborate upon or theorize this point, but it is more than a statement of the obvious and underscores the importance of explaining health inequalities with reference to complex sets of exposures and vulnerabilities2 that occur simultaneously or sequentially, vary across socioeconomic gradients, and have effects that often accumulate over the life course. In this issue, the study of Detroit by Kwarteng et al. 3 adds an important contribution to the literature on how the physical condition of neighbourhoods influences residents’ physical activity. Similar to many findings, this should direct our attention to macro-scale social and economic influences such as deindustrialization, rising economic inequality, racial segregation and the sorting effects of housing markets. As geographer Tom Slater has argued: ‘If where any given individual lives affects their life chances as deeply as neighbourhood effects proponents believe, it seems crucial to understand why that individual is living there in the first place’ (emphases in original).4 A recent editorial5 and forthcoming research article6 in the Journal describe differences in the epidemiological worlds typical of England’s distinct regions, whilst simultaneously suggesting the need for further investigation both of intra-regional differences and of social and economic policies that magnify economic inequalities7 or exacerbate regional divides.8 Arguably, these exemplify the ‘toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics’ identified by the WHO Commission on Social Determinants of Health9 as a root cause of health inequalities. Evidence is accumulating that trade policy can contribute to the persistence and widening of those inequalities, especially if its consequences for health are not rigorously assessed.10,11 Also in this issue, Greenberg and Shiau12 argue that the Trans Pacific Partnership Agreement is being negotiated without enough attention to those consequences, partly because of a lack of transparency in the negotiation process and partly because of inadequate awareness on the part of
public health researchers and practitioners—at least in the USA—of the connections between trade policy and health. The implication is that understanding influences on future epidemiological worlds, and the differences among them, requires looking upstream not only at a broad range of domestic policies but also at the commitments governments make in the international arena on behalf of their citizens. Closer to home, this issue of the Journal also features, under its Behavioural Factors heading, a focus on alcohol, with a guest editorial from Stephanie Scott and Eileen Kaner. As they correctly point out, this is a huge problem often overlooked in comparison to other major public health issues. We expect to return to it regularly.
354
E DI TO R I A L
9 Commission on Social Determinants of Health. Closing the Gap in A Generation: Health Equity Through Action on the Social Determinants of Health (Final Report). Geneva: World Health Organization, 2008. 10 Blouin C, Drager N, Heymann J (eds). Trade and Health: Seeking Common Ground. Montre´al: McGill-Queen’s University Press, 2008.
11 Blouin C, Chopra M, van der Hoeven R. Trade and social determinants of health. Lancet 2009;373:502 – 7. 12 Greenberg H, Shiau S. The vulnerability of being ill informed: the Trans Pacific Partnership Agreement and global public health. J Public Health 2014;36:355– 7.
Downloaded from http://jpubhealth.oxfordjournals.org/ at Universite Laval on July 7, 2015
Editorial Looking upstream for influences on socioeconomic inequalities in health
Ted Schrecker, Eugene Milne
References 1 Rydin Y, Bleahu A, Davies M et al. Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet 2012;379:2079 – 108. 2 Diderichsen F, Evans T, Whitehead M. The social basis of disparities in health. In: Whitehead M, Evans T, Diderichsen F, Bhuiya A, Wirth M (eds). Challenging Inequities in Health: From Ethics to Action. New York: Oxford University Press, pp. 2001, 13– 23. 3 Kwarteng JL, Schulz AJ, Mentz GB et al. Associations between observed neighborhood characteristics and physical activity: findings from a multiethnic urban community. J Public Health 2014;36:358– 67. 4 Slater T. Your life chances affect where you live: a critique of the ‘cottage industry’ of neighbourhood effects research. Int J Urban Reg Res 2013;37:367– 87. 5 Bambra C, Barr B, Milne E. North and South: addressing the English health divide. J Public Health 2014;36:183 – 6. 6 Copeland A, Kasim A, Bambra C. Grim up North or Northern grit? Recessions and the English spatial health divide (1991 – 2010). J Public Health 2014. doi:10.1093/pubmed/fdu019. 7 Stuckler D, Basu S. The Body Economic: Why Austerity Kills. London: Allen Lane, 2013. 8 Beatty C, Fothergill S. Hitting the Poorest Places Hardest: The Local and Regional Impact of Welfare Reform. Sheffield: Centre for Regional Economic and Social Research, Sheffield Hallam University, 2013. http://www.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/ hitting-poorest-places-hardest_0.pdf (date last accessed 14 August 2014).
# The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected].
353
Downloaded from http://jpubhealth.oxfordjournals.org/ at Universite Laval on July 7, 2015
The authors of a recent article on health and urban planning1 observed that ‘[r]ich and poor people live in very different epidemiological worlds, even within the same city’. The authors did not elaborate upon or theorize this point, but it is more than a statement of the obvious and underscores the importance of explaining health inequalities with reference to complex sets of exposures and vulnerabilities2 that occur simultaneously or sequentially, vary across socioeconomic gradients, and have effects that often accumulate over the life course. In this issue, the study of Detroit by Kwarteng et al. 3 adds an important contribution to the literature on how the physical condition of neighbourhoods influences residents’ physical activity. Similar to many findings, this should direct our attention to macro-scale social and economic influences such as deindustrialization, rising economic inequality, racial segregation and the sorting effects of housing markets. As geographer Tom Slater has argued: ‘If where any given individual lives affects their life chances as deeply as neighbourhood effects proponents believe, it seems crucial to understand why that individual is living there in the first place’ (emphases in original).4 A recent editorial5 and forthcoming research article6 in the Journal describe differences in the epidemiological worlds typical of England’s distinct regions, whilst simultaneously suggesting the need for further investigation both of intra-regional differences and of social and economic policies that magnify economic inequalities7 or exacerbate regional divides.8 Arguably, these exemplify the ‘toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics’ identified by the WHO Commission on Social Determinants of Health9 as a root cause of health inequalities. Evidence is accumulating that trade policy can contribute to the persistence and widening of those inequalities, especially if its consequences for health are not rigorously assessed.10,11 Also in this issue, Greenberg and Shiau12 argue that the Trans Pacific Partnership Agreement is being negotiated without enough attention to those consequences, partly because of a lack of transparency in the negotiation process and partly because of inadequate awareness on the part of
public health researchers and practitioners—at least in the USA—of the connections between trade policy and health. The implication is that understanding influences on future epidemiological worlds, and the differences among them, requires looking upstream not only at a broad range of domestic policies but also at the commitments governments make in the international arena on behalf of their citizens. Closer to home, this issue of the Journal also features, under its Behavioural Factors heading, a focus on alcohol, with a guest editorial from Stephanie Scott and Eileen Kaner. As they correctly point out, this is a huge problem often overlooked in comparison to other major public health issues. We expect to return to it regularly.
354
E DI TO R I A L
9 Commission on Social Determinants of Health. Closing the Gap in A Generation: Health Equity Through Action on the Social Determinants of Health (Final Report). Geneva: World Health Organization, 2008. 10 Blouin C, Drager N, Heymann J (eds). Trade and Health: Seeking Common Ground. Montre´al: McGill-Queen’s University Press, 2008.
11 Blouin C, Chopra M, van der Hoeven R. Trade and social determinants of health. Lancet 2009;373:502 – 7. 12 Greenberg H, Shiau S. The vulnerability of being ill informed: the Trans Pacific Partnership Agreement and global public health. J Public Health 2014;36:355– 7.
Downloaded from http://jpubhealth.oxfordjournals.org/ at Universite Laval on July 7, 2015
