Abstract
The Social Determinants of Health: Looking Upstream investigates various social domains and how the health of individuals is influenced by various factors outside their control. Author Kathryn Strother Ratcliff’s focus is on the United States and how various actors such as companies, the government, powerful individuals, activist groups, and regulatory agencies all have roles to play in the health of individuals. The author begins with a definition of social determinants of health and illustrates the impacts these large actors can have on individuals. Some of the issues have already been addressed; however, other actors are still fighting changes, and as a result they still affect the health of many people negatively.
Chapters are devoted to poverty and health, environmental health, water and health (cowritten with Devon R. Goss), automobiles and health, occupational health, and food and health. Each chapter highlights large actors “upstream” from the individuals they affect and the decisions made or the cultural impact that those actors then have on the health of individuals. The author also points to examples of successful movements and to other actors that have been able to counteract detrimental practices.
Ratcliff identifies patterns in how companies and corporations address challenges to their business practices, such as funding journals that only publish articles that cast doubt on the possible detriments of business practices. Another pattern identified is the delay of any action taken against the interests of those who are harming health, thus allowing more time to achieve maximum profit from current practices and allowing support to diminish. The author ends with strategies that will help to change the conditions of life that can lead to different health outcomes, as well as a brief discussion of health as a human right.