Documents 

Background

Focus on “social determinants of health” provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of “risk factors” related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of “social determination of health” has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis.

Discussion

In this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as “collective health” and “critical epidemiology” have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the “4 S” elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth).

Conclusions

We argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that “reverse innovation” must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.
[authors summary]

Social circus programs are expanding worldwide; however, little scholarship exists on their impact. Ecuador offers one of the world's largest government-sponsored programs, reaching almost 25,000 people annually. Aimed at promoting social solidarity and inclusion, programs are currently offered to street-involved youth, as well as children from marginalized communities and adults with disabilities. Identified tensions include the balancing of artistic versus social goals; integration of traditional social work approaches with social circus techniques and methodological challenges in evaluation. This program shows great promise and merits comprehensive interdisciplinary research, particularly regarding its impact on healthy equity. [authors summary]

Art for Social Change: A Research Partnership in Teaching, Evaluation and Capacity-Building (ASC!), involves researchers, community members, students and others from a wide variety of sectors and aims to explore how the arts are used to engage people and encourage positive change. A study of social circus is being led by Dr. Jennifer Spiegel of Concordia University as part of this five-year research program in art-for-social change. Dr. Spiegel’s research on social circus mainly uses ethnographic and other qualitative techniques; the purpose of this report is to provide some quantitative data about social circus in Quebec to contribute to Dr. Spiegel’s study as well as to contribute to the ASC research objective of developing various tools for researching ASC projects as well as for operational evaluations if and when appropriate.. One of the specific objectives of this report is to identify strengths and limitations of the approach used in this questionnaire survey. [author summary]