Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health

Tags:
Early View Perspective
Topics:
Social determinants of health

Policy Points:

  • Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations.
  • Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax-and-transfer system) institutions that produce health.
  • Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.

In 2022, President Biden convened the White House Conference on Hunger, Nutrition, and Health.1 This conference identified factors such as food insecurity, nutrition policy, and the built environment as determinants of population health and called for a ‘whole of society’ response, with government, businesses, and nonprofit organizations working together to improve the health of all Americans.

As this conference reflected, there is now wide recognition of the role that social conditions play in shaping health outcomes.2-5 Such recognition invites the question of what to do about social conditions that harm health. The approach advocated for at the White House Conference falls squarely into line with what has become the dominant answer to this question. I refer to this approach as ‘multisector collaboration’ because it emphasizes the need for different sectors in society to work together to tackle the health harms created by adverse social circumstances (‘cross-sector collaboration’ and ‘intersectoral collaboration’ are analogous terms).6-11

References

  1. Office of Disease Prevention and Health Promotion. White House Conference on Hunger, Nutrition, and Health. US Department of Health and Human Services. Accessed May 2, 2023. https://health.gov/our-work/nutrition-physical-activity/white-house-conference-hunger-nutrition-and-health
  2. Office of Disease Prevention and Health Promotion. Equitable long-term recovery and resilience. US Department of Health and Human Services. Updated December 5, 2023. Accessed August 4, 2023. https://health.gov/our-work/national-health-initiatives/equitable-long-term-recovery-and-resilience
  3. Social determinants of health. Centers for Disease Control and Prevention.2021. Accessed October 26, 2021. https://www.cdc.gov/socialdeterminants/index.htm
  4. Social determinants of health. World Health Organization. AccessedMay 10, 2021. https://www.who.int/westernpacific/health-topics/social-determinants-of-health
  5. Office of Disease Prevention and Health Promotion. Healthy people 2030. US Department of Health and Human Services. Accessed May 6, 2022. https://health.gov/healthypeople
  6. Institute of Medicine.The Future of the Public’s Health in the 21st Century. National Academies Press; 2002.

Citation:
Berkowitz SA. Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health. Milbank Q. 2024;102(2):1229.