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

Abstract

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.

Keywords: health equity; population health; social determinants of health; social policy; socioeconomic factors.

Figure 1

Multisector Collaboration vs. Social Democracy. A simplified depiction of the relationship among fundamental causes, superficial causes, and health is shown. Because any individual superficial cause is only one of several pathways between fundamental causes and poor health, addressing a specific superficial cause may not improve health outcomes, as the connection between fundamental causes and health can shift to other mechanisms. Social democratic policy typically focuses on fundamental causes, whereas multisector collaboration interventions typically focus on superficial causes.