In the 1980’s two well known public health professionals, from the global South and North respectively first described the need for a new socio-epidemiological paradigm for health system development, health policy, and health research.
Prof. D.Banerji of Jawaharlal Nehru University (JNU), New Delhi, researched 17 villages over time, visiting them year after year to understand community experiences and their views about health and health services, concluding that “Health service development is a socio-cultural processes, a political processes, a technology, and managerial process, with an epidemiological and sociological perspective.” (1)
Similarly Prof. Geoffrey Rose, at the London School of Hygiene and Tropical Medicine, Professor of Epidemiology, well known for his work on salt and hypertension wrote a book in which he stated “the primary determinants of disease are mainly economic and social and therefore its remedies must also be economic and social……. medicine and politics cannot and should not be kept apart.” (2)
Inspired by both these academics many health researchers including those of us in SOCHARA often also linked to civil society and social movements have explored the social, economic, political, cultural and ecological determinants of health to get a deeper understanding of health challenges going beyond the orthodox bio-medical, techno-managerial framework.
The People’s Health Charter emphasizes this new understanding when it reiterates in its preamble Inequality, poverty, exploitation, violence and injustice are at the root are at the root of ill-health and the deaths of poor and marginalized people...
“Health is a social, economic, and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence and injustice are at the root of ill health and deaths of poor and marginalized people. Health For All means that powerful interests have to be challenged….. and that political and economic priorities have to be drastically changed.” (3)
This is a new paradigm of public health and health systems policy research which will be at the core of our new efforts to bring health in all policies and promote the health for all goal.
In a meeting of epidemiologists, in the WHO/SEARO region this new understanding has been accepted as the way forward. A consultation on the application of epidemiological principles for public health action in 2009, mentions in its final recommendation that:
‘The scope and reach of epidemiology which is an integral part of public health must be expanded to include the study of the social, cultural, economic, ecological and political determinants of health and constitute the key stone for use of evidence for development of public health policy…… Such an approach will help in moving beyond health problems per se to new complex social and human development challenges such as the current crisis and threat to public health, posed by the global financial meltdown and climate change’ (4).
While referring to this larger framework of analysis that goes beyond bio medical and techno managerial analysis to the deeper social, economic, political, cultural and ecological determinants, we use the term SEPCE analysis.