An extract from the constitution of the World Health Organisation (WHO) helps frame this Module:
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” (Constitution of the World Health Organization, 1946)
Why is such a seemingly simple statement of belief, the right for every person to live a healthy life and to access health services when needed, so difficult to achieve? Should everyone not enjoy the benefits of good health, no matter their age, sex, race, religion, socioeconomic status, geographic location, health status, disability, sexual orientation, gender identity or migration status?
Being poor, being black, being a woman, being a migrant, living in a rural community or simply being historically linked to discrimination or exclusion, increases your likelihood of becoming ill and increases your chance of death because you are unable to access or afford the health services you need. Additionally, living with capitalism and its logic means that you are constantly exposed to profit driven marketing of harmful goods and unhealthy foods such as tobacco, alcohol, sugar-sweetened beverages and cheap fast food alternatives. If you live in South Africa, your health has been severely compromised by colonialism, Apartheid, increasing income inequality, climate change and environmental degradation and corruption. And as COVID-19 has so acutely illustrated, infectious disease follows the most vulnerable and marginalised populations. Without sufficient and nutritious food, without safe, clean drinking water and sanitation, without safe and adequate housing, without education, without freedom from violence, without safe working conditions and without access or opportunity for medical care we will continue to face the increased likelihood of getting sick and will die. Contrast this to the South African reality of those who have a decent job, adequate shelter, medical aid and access to several other opportunities, who are less likely to become sick and die.
We will continue our overt framing of health as a structural and social phenomenon and therefore health inequity as a key lever for social change. Like in Module 2, this will not be presented as abstract. It will be presented as a story that presents real things concerning real people, communities in action, helping us deepen thinking on how to approach and conceptualise our SCIs.
- Structural determinants – the institutional and systemic mechanisms that determine how power is distributed and resources are allocated;
- Social determinants – the conditions under which people live, eat, learn, work and interact;
- Commercial determinants – the profit driven industrial and commercial corporate activities promoting harmful goods and unhealthy food.
This time we do so by visiting some key sites of learning, spaces where social determinants of health are manifest, but also where they are being challenged. All our sites have been associated with historical struggles for solidarity and the empowerment of the deprived and we think that they will form a powerful framework for understanding SSDOH, health inequity and for better framing of advancing health equity, as the core of collaborative social change initiatives Fellows are working on.
The objectives of these site visits are to:
- Develop empirical perspectives on the SSDOH, with a specific focus on land, housing, food systems, farmworkers and their living conditions, and the gendered realities of the public health system
- Hear and observe the activism and participation by affected communities in the design and implementation of policies to address SSDOH
- Learn from activists, social movements and community struggles against socioeconomic precariousness
- Deepen the application of the political economy as a tool for analysing the health system and its social context, building on what we did in Module 2
- Deepen our thinking about how these learnings can strengthen Fellows’ SCIs, their communities, and ultimately in identifying levers for intervention in the reduction of health inequities.
By visiting these sites and in learning from these communities, we once again break down and simplify what could potentially be complex, including:
- Land dispossession
- Health as essential to life and survival
- The structures and systems that define health and determine health outcomes for different segments of society
- Interests, struggles and contestations over resources
- Unfair and avoidable differences in health based on race, class, gender and space/location
- The failure of the state
- Struggles, advances and the making of alternatives
- Empowerment of communities over the factors that determine their health
Key questions and themes that inform Module 3
The key questions and themes that inform the curriculum for Module 3 are:
- Where do health differences among social groups originate, if we trace them back to their deepest roots?
- What pathways lead from these root causes to the stark differences in health status observed at population level?
- How do we understand the social phenomenon around education, farmworkers and their living and working conditions, food and nutrition and women’s health, and their contribution to health inequity?
- What or whose interests and politics shape structural and social conditions and the manifestation on health inequities?
- What role has the South African state played in current health systems failures and successes – health as a right, universal healthcare, primary healthcare, policy, trajectory, resourcing, financing, corruption, etc.
- Where and how should we intervene to reduce health inequities? And how can we do this through elevating indigenous health knowledge and feminist ethics?
If we had time: missing Module 3 elements
As always it is not possible to cover everything we would have wanted to in just one Module. We encourage Fellows to do their own thinking and research to deepen their knowledge. We are also hoping to hear from you, if there is something that you think is critical within the broader module framing and thematic area, that we absolutely must consider.
We also encourage you to work through the readings provided either in the materials and/or in the additional reading pack. These readings were put together to enhance your thinking and learning in Module 3.
In designing this Module, we did not grapple with as many ‘missing’ module elements as we did for Module 2. There were just two, from our end, but again time and design did not support us. We would have loved to:
- Explore social determinants beyond the four that we have emphasised. There are many other important and critical determinants in the local context that could be explored
- Look at the NHI and its relationship to the SSDoH, what it is about, its potential, its limits, how far legislation and implementation has progressed, struggles and contestations over it, its likely trajectory and alternative models.
We note these. We hope Fellows will explore additional social determinants in their own time and we commit to picking up on the NHI in Module 4.