Social determinants key in who gets good care

Kerala is one of the poorer states in India, and yet it enjoys India’s highest life expectancy and lowest infant mortality rates. This seeming anomaly has caused many to wonder what Kerala is doing right. Dan Brock thinks the answer may be found through work on the social determinants of health.
“The principal explanation is that Kerala has high literacy rates, especially among women, and it turns out that this is a major factor in determining the health of a population. When women are educated, they become more independent, they’re better able to respond to health literacy efforts, and better able to seek out health care.”

As director of the recently launched University-wide Program in Ethics and Health, as well as director of the Medical School’s Division of Medical Ethics, Brock is helping to guide bioethics (a field he helped create) in a new direction.

Brock works in conjunction with five prestigious and influential scholars who form the steering committee for the Program in Ethics and Health: Allan Brandt of the Faculty of Arts and Sciences (FAS), Norman Daniels of Harvard School of Public Health (HSPH), Frances Kamm of the Kennedy School of Government (KSG) and FAS, Robert Truog of Harvard Medical School (HMS) and Daniel Wikler, HSPH. In addition to focusing on ethical dilemmas that primarily affect individuals (abortion, reproductive decisions, end-of-life issues), Brock and his colleagues are addressing policy issues that affect the health of entire populations, an area that many predict will become increasingly important over the next few decades.

“Some of the major determinants to health are not access to health care but what are called social determinants, factors like literacy, education, sanitation, transportation, clean water, socioeconomic equality. You’ve got to pay attention to other things beside the health care system. If you don’t take the broader view into account, you close your eyes to most of the things that impact the health of the population.”

A trained philosopher and the author of three important books on medical ethics – “From Chance to Choice: Genetics and Justice” (with Allen Buchanan, Norman Daniels, and Daniel Wikler, 2000), “Deciding for Others” (with Allen Buchanan, 1989) and “Life and Death” (1993) – Brock began shifting his interest toward broader health policy issues in the mid-1990s. The change came about partly as the result of his appointment in 1993 to the Clinton Task Force on National Health Care Reform. Although the task force was unsuccessful in bringing about a basic restructuring of the national health care system, Brock found the experience of working with the group an extremely enlightening one, which profoundly influenced the future course of his career.

“It reinforced my wanting to work on issues of broader health policy and population health.”