The Social Determinants of Health: Looking Upstream

by Kathryn Strother Ratcliff

This timely book takes seriously the idea of understanding how our social world – and not individual responsibility or the healthcare system – is the primary determinant of our health. Kathryn Strother Ratcliff puts into practice the "upstream" imagery from public health discourse, which locates the causes (and solutions) of health problems within the social environment. Each chapter explains how the policies, politics, and power behind corporate and governmental decisions and actions produce unhealthy circumstances of living – such as poverty, pollution, dangerous working conditions, and unhealthy modes of food production – and demonstrates that putting profit and politics over people is unhealthy and unsustainable.   While the book examines how these unhealthy conditions of life generate significant class and ethnic health disparities, the focus is on everyone's health. Arguing that none of us should be placed in health-threatening situations that could have been prevented, Ratcliff's provocative analysis uses social justice and human rights lenses to guide the discussion "upstream," toward possible changes that should produce a healthier world for us all. Using data and ideas from many disciplines, the book provides a synthesis of invaluable information for activists and policymakers, as well as for professionals and students in sociology, public health, and other fields related to health.

Genres: Health, Nonfiction

256 pages, Hardcover

Published September 18, 2017

Reviews

[becca barry · Rating 3 out of 5]

The SDoH have been something that I talk about nonstop in relation to both chronic and rising public health issues. I am a huge believer in preventative medicine, and cultivating a healthy population as opposed to being solely reliant on intervention at crisis point. I think it is vital to acknowledge personal responsibility, but not end up vilifying individuals for their ‘irresponsible’ and ‘uneducated’ health behaviours without considering the structural constraints that they operate within.

I think this book did a great job at defining the overarching messages and benefits of looking ‘upstream’ at the causes of ill health. It was well structured and very easy to follow, and supported by a lot of interesting case studies. The concrete examples really gave gravitas to the overall arguments and I will definitely be looking in more detail at many that were specified.

However, perhaps because this is an area that I have looked into in depth previously, I found a lot of the rhetoric quite basic and relatively obvious. This is not to say that there is no use in stating outright the existing situations and circumstances, and naming the major players, especially where governments and corporations often seek to obscure reality or mislead the population. It brings much benefit and a wider perspective in areas where public health perspectives might be becoming too narrow or internal. I would say, however, that if you are already quite well versed and aware of the SDoH concepts, I am not sure that this book will bring too much new information to the table.

[Kevin Woodson · Rating 5 out of 5]

SDoH book

This is a great book to learn the upstream causes to dishonestly crises. The Social Deteamnets of Health is a subject to study on the get a better idea in who is trying to help and whom is not.

[Sydnee Wall · Rating 4 out of 5]

"About 20 percent of the nation's health is the result of medical care, while 5 percent is the result of biology and genetics, 20 percent is the result of individual actions, and over 50 percent is caused by the social determinants of health" (CDC 2011)

Ratcliff offers a great perspective on an alternative way to conduct a needs assessment--by looking "upstream". Being in healthcare is like saving drowning people in a river. Hear the cry for help. Pull to shore. Apply artificial respiration. Hear another cry. Pull to shore. Apply artificial respiration...again and again as the cycle never stops and the people of healthcare are left burnt out and apathetic (COVID-19 anyone?). Ratcliff proposes that we have to take a look at what--or who--is pushing people in the damn river if we're to ever escape this cycle. You might be surprised to find out who it is.

[Ari Mahonen · Rating 4 out of 5]

The 9 sections of the book cover a different social determinant of health. Each had many great points. This was required reading for my Environmental Justice class. I think it was a great introduction of the concepts of SDoH. It gave great examples of how the world around can determine the the well being of society.

[Tao Chen · Rating 5 out of 5]

Amazing book. Really delves into the social and political complexities on health in American becomes more of a commodity rather than a right.

[David · Rating 4 out of 5]

Fascinating

[Carla · Rating 3 out of 5]

Looking forward to the update version of this book. Pre-pandemic writing about SDOH is challenging because of the many changes brought about since 2017. Overall, it was a great book that made me think about life, illness, and chronic stress differently. There is no equality here.