Social determinants of health: perception, misperception and utter lack of perception

University of Waterloo professor Kelly Anthony has been troubled by her undergraduate students’ lack of awareness of the determinants of health – especially the social determinants of health (SDH) – which she’s observed over a period of years. She’s concerned, too, that students in Waterloo’s master of public health program receive limited exposure to the subject in their course work, and that and that the subject is an elective, not a required course. Anthony began her Friday afternoon presentation, entitled Public Perceptions of Determinants of Health, by sharing her concerns and her recognition that public health education does not appear to take social justice into account.   

In terms of the messages about social justice, Anthony concedes that “the public doesn’t get it – because we haven’t done a good job of conveying them to the public.”

Recent literature on the perceptions of the SDH – and there’s not much of it, reports Anthony – indicates that more people believe that we have more agency in our overall health than we actually do. And research suggests that this misperception is getting worse, and that people are increasingly less likely to attribute others’ life circumstances health status to factors other than individual choice and action or inaction.

Presenting with Anthony was undergraduate student Danielle Kofler, who had been completely unaware of the SDH before she took Anthony’s course, and, she says, the course “completely transformed” her thinking. Kofler conducted her own small-sample study of the attitudes of predominantly female subjects within the university community toward agency and choice. The findings supported what Anthony has observed in her students: individuals’ agency and choice were consistently overestimated and the role of outside factors were downplayed or denied.

In terms of what can be done to increase the general awareness of social justice and the SDH, Anthony suggested that the government assume responsibility for promoting human rights and that increased public engagement be encouraged. Students need to be taught about these issues, and much earlier than in university. And the public health community must work harder at better messaging and better strategies for communicating those messages.

In the lively conversation that followed the presentation, the Wellesley Institute’s Bob Gardner recommended the Monopoly-style board game The Last Straw and the work of the Robert Woods Johnson Foundation as useful resources.