SOCIAL DETERMINANTS OF HEALTH
Socially dependent individual health capabilities and collective health capabilities
WHAT IS IT?
Health capability is not just a set of individual skills, nor is it simply a refrain of the social determinants of health. It is a set of conditions and abilities, internal and external, that enable optimal individual and collective health. To measure individual health capability, we need to assess societal-level factors on which health capabilities depend and vice versa. Furthermore, we need to assess the dynamic between internal capabilities and external capabilities.
Social determinants of health refer to social and economic factors impacting individual and population differences in health. They include how and where people are born, live, work, etc. Social determinants of health include social and economic status, education, social support, access to health care, and more.
However, social determinants of health do not fully capture individual and collective health capabilities.
These approaches draw inferences about groups based on individual-level data and about individuals based on group-level data. Socially dependent health capabilities and collective health capabilities illustrate how both individual- and group-level factors combine to create health capability of individuals and society.
WHY IS IT IMPORTANT?
Many different factors influence health. But we need to consider how individual- and group-level variables influence individual and collective health capabilities. We need to fill the void in knowledge about how to implement good health and policy reforms.
Individual- and group-level variables both influence individual health capability, but we need to better contextualize their effects on one’s health capability. Socially dependent capabilities for health allow us to understand what impairs or enhances one’s ability to be healthy. Collective capabilities can help us understand the impact of external factors on one’s health agency and health functioning and vice versa.
WHAT DOES IT LOOK LIKE?
An emphasis on socially dependent capabilities for health applies to longitudinal policy and institutional analysis over time. Furthermore, this approach allows for a nuanced, flexible, multidimensional, and dynamic understanding of individual and collective health capabilities.
While the individual is the unit of analysis for evaluating health policy and institutions, collective capabilities are essential to individual and population health. Through socially dependent health capabilities, we can understand how individual and social factors interact to affect individual health capability. We can then understand external factors at the individual level and the collective capabilities needed for optimal health.
Differences in health capability help explain why COVID-19 differentially impacts individuals and population groups. We see how components that are internal and external to the individual, and interactions between internal and external factors, influence one’s ability to survive and thrive amid the COVID-19 pandemic.
For example, internal capabilities, such as one’s level of health knowledge, health values and goals, and intrinsic motivation towards health, impact their ability to understand the disease, mask protection, and social-distancing and isolation guidelines. At the same time, external capabilities, such as society’s views of race, ethnicity, class, gender, sexual orientation, as well as societal prospects for employment and housing, shape their individual abilities and conditions to obtain optimal health and flourishing. These factors influence one’s access to valuable social networks and environments, economic opportunities, high-quality prevention and treatment, financial resources, and more.
Additionally, our collective health capabilities help illustrate how what we do collectively as a society - together - formulate the commitments and resources we need to effectively combat the COVID-19 pandemic. Consistent, efficient, equitable communication and action from public health institutions and the government enable individuals and communities to have good access to COVID-19 tests, treatment, vaccinations, guidelines, and knowledge. Thus, by accounting for both internal and external influences at the individual level, and the role of collective capabilities at the societal level, we are able to understand the abilities of different individuals and population groups to live healthy, flourishing lives.
HOW DO WE DO IT?
Our health and social systems should make a shift to internalize the concepts of internal and external health capabilities. Policymakers and providers should use these methods to examine the conditions for optimal health and current requirements for and barriers to achieving it. Health-related policy and institutions should be grounded in the idea of building internal and external health capabilities. They should focus on the individual and collective capabilities necessary to achieve optimal health for all individuals and populations.