Historical perspectives

The social determinants of health (SDOH) concept is now firmly entrenched in the contemporary public health literature with its recognition that living and working conditions are the primary factors shaping health. But even then, there remain fundamental differences in how these social determinants are conceptualized with regard to their causes, the means by which they determine health, and the responses necessary to improve their quality and equitable distribution. In this chapter, the authors show how these differences in conceptualization are rooted in ideological views of the nature of society that were apparent as early as the mid-19th century and continue to shape contemporary theory, research and practice. These three major traditions, hygienic, liberal and political economy, whose primary proponents were Edwin Chadwick, Rudolph Virchow and Friedrich Engels, respectively, map onto contemporary interpretations with regard to the nature of the SDOH and means of improving their quality and distribution. They suggest that the current polycrisis associated with late-stage global capitalism indicates that it is the political economy perspective that offers the most useful way of understanding the SDOH and providing the means by which their quality and equitable distribution can be improved.