Projects on Public Health and Social Quality
Here, we present short summaries of public health related social quality projects, from 1995 to the present.
- 1995-2000: A Dutch work group Connecting public health with the social quality perspective
- 2010-2014: Public Health and Social Quality of the Flinders University in Australia
- 2014-2015: Applying the Social Quality Perspective to the History of Public Health in the USA
- 2014-2016: Determinants of Health and Social Quality of the Sheffield University in the UK
- 2015-2017: The Dutch work group revisited
- 2020-ongoing: The start of Explorations of Societal Consequences of COVID-19
A Dutch Work Group Connecting Public Health and the Perspective of Social Quality
Already in the late 1990s, the policy area of public health was at the cradle of social quality thinking. It may be seen as a major hinge point between the so-called objective reality (referring to the conditional factors of sq) and the subjective reality(referring to the constitutional factors of sq) people are coping with. In the late 1990s, thanks to the first outcomes of the work of social quality scholars, a Dutch work group - supported by the m municipality of The Hague the Netherlands Interdisciplinary University Institute SISWO in Amsterdam - started a project to analyze public health practices from the social quality perspective. This project enabled collaboration with public health experts in the UK and Canada. Explorations were made of the Community Health Hospital in Lambeth in London and talks were held with experts in Liverpool who were engaged with their prominent work in the Healthy City Movement. In Toronto and Montreal they did explorations in community health care centers and participated in discussions about a new philosophy of community health. Thanks to this work, both Dutch organizations took the initiative to organize the first Dutch Healthy City Conference. In 2000 the hereupon based study is published in the International Journal of Epidemiology and Community Health.
Based on these forms of explorations, participation and studies concluded is among other things, that in the nineteenth century, the old public health oriented toward biological hygiene of urban and domestic spaces, changed into a natural scientific epistemology. This single scientific orientation simply cannot conceive of ‘public’ as a reality of societal configurations: “we do not criticize the significance of this scientific work in the context of medical policies, but we do have questions regarding it as the scientific cornerstone of modern public health”. In 1994 The Lancet editors concluded already that common epidemiological research has always been based on simplistic notions of causality. Reference was made to the Leeds Declaration of 1993, which states that traditional epidemiological methods are too blunt to dissect the complexities of today’s health problems. The research Unit in Health and Behavioral Chance at Edinburgh University concluded that “mainstream epidemiology has little to offer in modernizing public health, that its positivistic orientation underscores a principal weakness in it understanding of the societal dynamic of health and disease, therefore undermining its ability to effect change in public health. The fundamental issue concerns what we precisely mean by the causes and effects in modern public health issues”. In this perspective, as a noun, ’public’ remains a metaphor for an aggregation of separate individuals. It therefore logically dismisses communities as societal configurations with specific characteristics attributable to given socio-political, socio-economic, socio-cultural and socio-environmental relationships and related norms, values, and orientations. And this caused the fact that according American public health experts, the public health in that country has lost its edge (Amani Othman and William W. Darrow in the International Journal of Social Quality).
Public Health and Social Quality of the Flinders University in Australia
A decade later, also Australian public health experts embraced the theory of social quality as a point of departure for a new approach of public health. This delivered for them points of departure for the application of elements of the social quality approach (SQA), to facilitate a more complex and complete understanding of the so-called positivistic oriented so called ‘social determinants of health’ (SDH). This was also an outcome of some international conferences on social quality in Japan, Thailand, Hong Kong, China, South Korea and Taiwan. Thanks to the previous projects of the Flinders University, its Department of Public Health started a project to approach from a broader public health perspective societal modernizing processes in Taiwan, Hong Kong, South Korea, Japan, Australia, and Thailand. This approach has been linked to an understanding of the consequences of an increase or decrease in general mistrust, potentially signaling sociopolitical and socioeconomic problems and on trust in family, neighbors, strangers, foreigners, and people with a different religion, all of this in relation to health of people. The outcomes underpinned the thesis, that complex problems require complex solutions and that the social quality approach is highly important to address the question of societal determinants of health of people, published in BMC Public Health in 2011.
Applying the Social Quality Perspective to the History of Public Health in the USA
The public health expert from the USA from the Florida University – William W. Darrow – started with Dutch colleagues a project to apply the social quality perspective to the history of the public health in the USA. At this stage, USA public health has lost its edge. It made a significant impact on human well-being, capacities, and potential in the late nineteenth and early twentieth century. Now it takes a backseat to biomedical research and therapeutic medicine. For example, the Centers for Disease Control and Prevention in the USA reported that after a stable period from 2000 to 2007, the rate of suicide among those aged 10 to 24 has increased significantly in the past years, making suicide the second-leading cause of death in this age group to-day. And American experts noticed, that these outcomes demonstrate, that heavily invested is in crises care, which is the most expensive and least effective means of preventing suicide. The SQA may deliver an answer to the application of the methodological individualism, which denies societal causes of biophysical harm, suffering, and isolation of people. Furthermore, the assumptions underlying this methodology deny capabilities of individual people and their immediate environment and communities to go beyond this state of existence. He demonstrates this with help of the failure to control the spread of human immunodeficiency virus (HIV) in this country. This can be attributed tot adherence to an inadequate biomedical model that ignores ‘the social’ as elaborated in the theory of social quality, designed to further social justice, solidarity equal value, and human dignity. The societal consequences of the COVID-19 pandemic in the USA since January 2020 confirms the conclusions made by William Darrow in the International Journal of Social Quality in 2015.
Determinants of Health and Social Quality of the Sheffield University in the UK
In 2018, two English experts – namely David Holman and Alan Walker - published in the Journal of Social Indicators Research a study about the social quality perspective for testing the utility of this approach in explaining self-rated health as a response to arguments that the framework of ‘social determinants of health’ (SDH) often lacks enough theoretical basis. It is an outcome of a huge project of the Sheffield University in the UK, applying multilevel models to analyze national English and Welsh data (the Citizenship Survey) to test for both individual- and neighbor-level affects. One of the conclusions is that neighborhood contextual (cross-level) effects are present with respect to collective action, personal trust, cross-cutting ties, income sufficiency, and income security and that the conditional factor of socio-economic security – and especially its domains of housing security, income sufficiency, and income security determinants - is especially important. Furthermore, social rights, including institutional but especially civil rights, have effects of particularly large magnitude. Therefore, the social quality theory and approach deliver a theoretically driven perspective on the SDH, which has important policy implications and suggests several promising avenues for future research. This research demonstrated, that this social quality framework offers an opportunity to move beyond individual socioeconomic status factors and consider holistic policy initiatives. In order to maintain the public health for all members of society, we should focus not only on the power and resources that flow from different societal positions. It considers how society as a whole allows for and promotes empowerment, cohesion, inclusion and socio-economic security.
The Dutch Work Group Revisited
Thanks to this previous work (see above) a Dutch ‘work group public health and social quality’ continued explorations of public health processes in the city of The Hague. This delivered new building blocks for designing the concept of contemporary public health. This project resulted into a study, published in the International Journal of Social Quality [ verwijzen naar studie van Harry Nijhuis zonder naamvermelding, 2017..] Popular concepts like ‘positive health’, ‘comprehensive approaches’, and ‘participation’ represent only specific aspects of large complexities. Thanks to the previous study of 2000 (see above), a more holistic comprehension of public health could be designed. First two strands of reasoning, on which his argument is based, are discussed: (1) interpretation regarding major public health discourses of the past two centuries; (2) critical appraisal of influential societal tendencies (to be able, to identify what today is ‘appropriate’). Then, based om these interpretations, notions are developed regarding ontological, epistemological, and societal aspects of public health. This leads to the discussion of adequate methodologies for today’s practice of public health. Argued is, that in addition to the attention for the societal based conditional factors on behalf of public health policies (see the work in Australia and the UK), attention for the subjective or constitutional factors is needed for understanding the situation of people and what they need from public health support. With this in mind and with support of the social quality approach, presented is critic on current Dutch policies with regard to community health, or better ‘anti-community health’, resulting into an individualistic-positivistic approach: “complex health issues that are strongly embedded in interpersonal and societal contexts – like the prevention of HIV/AIDS and alleviating loneliness of the elderly – need to be based on the participation of several stakeholders, in particular, citizen communities. Distinct issues require appropriate, distinct, tailor-made patters of participation of stakeholders. Sometimes putting professional or government on the foreground, in other cases requiring citizen communities to set the tone in daily circumstances.”
The Start of Explorations of Societal Consequences of COVID-19
During the preparation of the issue Vol. 10.1 of the International Journal of Social Quality, the authors were confronted with the outbreak of the COVID-19 pandemic. For this reason the Editorial of this issue dedicated its attention also to this dramatic happening. This event thoroughly transcends the issue of the health of people as such. It affects almost all living conditions and the all-encompassing challenge of the sustainability of human life on earth, including flora and fauna. An emerging hypothesis is that pandemics like this one are partly determined by the nature of the current modern ways of life, which drastically disturb the balance of ecological systems. Inevitably, citizens, policymakers, and scientists are confronted with extremely complex challenges that—logically—must be approached in comprehensive ways. Considering its topical relevance, the Editorial of this issue explored the first societal aspects of the COVID-19 pandemic in some countries, because it is intimately tied with both academic activities in general and with the field of social quality in particular. For many reasons, all countries are now facing completely unknown challenges, and this has far-reaching consequences for the academic world. This also applies to the social quality approach (SQA) as a source of orientation for this journal. With this argument in mind, this editorial present the first brushstrokes with which to explore also the new context for the subjects of all articles, published in this issue. Thanks to this work and discussion within the Editorial Board, the plan is made to pave the way for a project about the societal consequences of the COVID-19 pandemic. During the autumn of 2020 scientists of the following countries explained to participate: from Australia, Brazil, China, Germany, India, Italy, Japan, Netherlands, Russia, South Africa, UK, and the USA.