Social determinants of health
A social determinants of health frame helps understand the place of food in promoting individual and community health. In a social determinants approach, primary care is only a piece of the health story. Issues of income inequality and other systemic environmental challenges, including the structure of the food system, are bigger issues to be addressed. Consequently, larger strategies to promote optimal population health are ultimately much more significant than primary care, which focuses on individuals and families typically without much attention to the larger environment in which they are situated.
In the Engine of Well Being Framework (Jayawickreme, Forgeard, & Seligman, 2012), work, income, education, capacities and related factors are inputs into human wellbeing. Other parts of the model address processes (internal states that influence individual choices) and outcomes (behaviours that reflect wellbeing, including relationships, engagement and contribution to human society).
Discourses (adapted from Foucault, 1979; Beagan Chapman, 2017)
Dominant discourses have an impact on how people think and behave (setting social standards), including what people perceive possible for themselves and for society. Our dominant institutions and media often promote them, and such messages then typically circulated through the informal avenues of day to day interactions. What constitutes healthy eating, who is worthy of support by the state, prioritizing the economy over the environment, all these are areas where discourses can have significant impacts on everyday thought. Often people and decision makers are unaware of these discourses and how they shape their views, in part because a dominant discourse of Western societies is individual and free choice. For many researchers, discourse analysis is an important component of understanding why things do and don't happen. There are also alternative discourses, though these are often marginal relative to the dominant ones.
"Healthy Communities are based on the following principles:
- Health is a state of complete physical, mental and social well-being.
- Social, environmental and economic factors are important determinants of human health and are inter-related.
- People cannot achieve their fullest potential unless they are able to take control of those things which determine their well-being.
- All sectors of the community are inter-related; sectors need to share their knowledge, expertise and perspectives and work together to create a healthy community.
A Healthy Communities process involves:
- Equitable community engagement
- Intersectoral partnerships
- Political commitment
- Healthy public policy
- Asset-based community development
Qualities of a Healthy Community include:
- Clean and safe physical environment
- Peace, equity and social justice
- Adequate access to food, water, shelter, income, safety, work and recreation for all
- Adequate access to health care services
- Opportunities for learning and skill development
- Strong, mutually supportive relationships and networks
- Workplaces that are supportive of individual and family well-being
- Wide participation of residents in decision-making
- Strong local cultural and spiritual heritage
- Diverse and vital economy
- Protection of the natural environment
- Responsible use of resources to ensure long term sustainability"
The process, typically driven by government, of restricting mainstream consumer choices to achieve broader social goals such as pollution reduction, improved health and sustainability.
The precautionary principle, as elucidated in the 1992 Rio Declaration on Environment and Development, calls for regulatory action in the face of serious environmental risks even in the absence of full scientific certainty. For an early history of the concepts development, evolution and use in regulatory environments, see Sand (2000). For some of the main critiques of the principles, see Science for Environmental Policy (2017).
The most robust international conception is likely that of UNESCO (2005:14): "When human activities may lead to morally unacceptable harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm. Morally unacceptable harm refers to harm to humans or the environment that is threatening to human life or health, or serious and effectively irreversible, or inequitable to present or future generations, or imposed without adequate consideration of the human rights of those affected.” (UNESCO 2005, p.14).
Perspectives for understanding personal food choices (from Sobal and Bisogni, 2009; and Monterossa et al., 2020)
There are 3 dominant perspectives used to analyze food choices.
- Rationalist perspective - assumes individuals maximize benefits and minimize costs.
- Structuralist perspective - assumes social institutions and environmental factors shape decisions
- Constructionist perspective - assumes that the process of making decisions is shaped by experience, interpretation, negotiation, management, and symbolizing social context.
It is common to use a mix of frameworks to identify the determinants of individual food choice and associated processes, although the rationalist perspective is more associated with traditional economic approaches.
"The determinants of food choice can be represented through a multilevel socioecological framework with concentric circles .... These multilevel determinants interact to influence food-related attitudes and beliefs. Interactions of the individual with the social and physical environment influence food choices and dietary behaviors." (Monterossa et al., 2020:562, figure 1).