The silencing of health research data: time to rethink social determinants

The new 10-year plan for health reform is ambitious, aiming to shift from a traditional reactionary treatment model to more proactive, prevention focused approach.

The plan seeks to galvanise a wide range of stakeholders – from policymakers implementing measures to curb unhealthy behaviours, to commercial retailers such as Danone, who have pledged to reduce harmful levels of fat and salt in their products, and Sainsbury's commitments to healthy eating such as their ‘great fruit and veg challenge’. Strategies might also capitalise on the evident upsurge of people’s knowledge and proactiveness in managing their personal health, as reflected in significant increases in the market for health and wellness products.

These efforts are to be welcomed. As a veteran health professional, I have long awaited such a shift and apparently focused attention. However, without wishing to resound the proverbial ‘I’ve been around the block a few times’, I would like to draw attention to ominous forces that might throw a spanner in the works for the government’s plans.

This country still has wide and widening health inequalities. Whilst we know that individual lifestyle behaviours – such as tobacco use, harmful alcohol consumption, and obesity – are among the biggest contributors to making us an unhealthy nation, and that we must also do something about improving the environments in which people live and grow, because they play a crucial role in determining good health or otherwise, we must not forget other key antagonists outside the control of individuals and governments.

What of the influence of politics and commercial interests in supressing the ability of people to adopt healthy behaviours? Such forces are reported to have more influence on health outcomes than individuals or government.

Commercial harms

The largest transnational corporations (TNC) – which are just four industries (tobacco, ultra-processed food, fossil fuel, and alcohol) – are responsible for escalating rates of avoidable ill health and contributing to social and health inequity. TNCs account for a third of global deaths, not to mention the havoc and destruction they wreak on the health of the planet.

TNCs have been charged with creating ‘a pathological system in which commercial actors, such as the aforementioned, are increasingly enabled to cause harm’. Worst of all, the costs of fixing such harm is externalised, meaning governments must meet the costs of fixing the harms but have little power to mount effective responses.

The personal is political

Political Determinants of Health (PDOH) are an overlooked element in research and government strategies, yet they are fundamental for understanding population health and health inequities. These legal, legislative, ordinance, regulatory or other policy decisions are behind virtually every social determinant of health, inducing for example, poor environmental conditions, inadequate transportation, unsafe neighbourhoods, poor and unstable housing, and lack of healthy food options for the most vulnerable in society.

These untoward conditions, in turn, can impact on the mental health of people and drive unhealthy behaviours with alcohol and tobacco consumption. They have been shown to directly impact population health outcomes including infant mortality, vaccination uptake, and women’s health.

We should, therefore, be seriously concerned about current political trends in Western nations. More conservative political ideologies have traditionally favoured the interests of private sector organisations and cultural traditionalism over government programs, policies, and regulations that prioritise social equity and collective good. Current trends threaten to destabilise people’s living conditions; economic security and their fundamental rights to access and use healthcare. The risks to the health of minoritised people, who traditionally hold less societal power, is particularly concerning.

Policies that cut or limit funding for aid and research programmes, often motivated by short-term political gains, can have far reaching and long-lasting effects. Recent imposed limitations on academic and scientific health research, which aim to translate evidence into practice is alarming. How will our governments respond?

We should be reminded that people, not governments, have the collective power to curb threats to the systems that sustain all our lives in our interdependent health ecosystems.

Dr Pamela Davidson-Knight, Senior Research Fellow, School of Midwifery and Community Health