Making the invisible visible: Effective learning on equity and the social determinants of health

The World Health Organization's Commission on the Social Determinants of Health made recommendations about the need for improved training and education on the social determinants of health and health equity for health professionals, health sector personnel and the general public. This paper will draw on experience from university teaching, workforce development training and research on comprehensive primary health care in Australia to examine some of the barriers to and enablers for encouraging learning about the social determinants of health.

Important barriers we identify are: 1) the tendency for health services to focus on the tip of the iceberg of health problems rather than looking at and taking action on the invisible factors causing ill health 2) the underlying philosophy of individualism which underpins professional practice and political and health systems in Australia and the USA and makes a reversion to behavioural change strategies hard to resist 3) the absence of policy frameworks to support action on the social determinants of health and health equity and encourage co-operation rather than competition between sectors . Our experience suggests that education and training can be made more relevant when it examines the values, ideologies and politics underpinning the provision of health services and examines how they reproduce unequal power relations; is directly supported and encouraged by management in health services and universities in terms of policy statements and practice models; provides practical examples of how a quest for equity and action on the social determinants have been put in to practice.