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      Uma análise crítica da abordagem dos Determinantes Sociais da Saúde a partir da medicina social e saúde coletiva latino-americana Translated title: A critical analysis of the social determinants of health approach from the perspective of the latin american social medicine and collective health

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          Abstract

          O enfoque dos Determinantes Sociais da Saúde tem tido ampla difusão e foi aparentemente bem acolhido globalmente. Este artigo assume uma visão crítica desse enfoque, buscando sistematizar as críticas principalmente provenientes de debates no interior da medicina social e saúde coletiva latino-americana, que se articularam ao redor da diferenciação entre Determinantes Sociais da Saúde e a determinação social dos processos saúde-doença. Pretendemos examinar estas diferenças para problematizar a aparente unanimidade retórica em prol da equidade. Ainda que a abordagem dos Determinantes Sociais da Saúde marque um enorme avanço na mobilização pela equidade em saúde, em nossa avaliação ela não consegue ser mais do que um avanço incompleto.

          Translated abstract

          This article seeks to critically analyze the Social Determinants of Health approach and proposes a synthesis of the critique that has shaped the debate and particularly found expression in the differentiation between SDH and the Latin American Social Medicine and Collective Health 'social determination of the health-disease processes' approach. Reexamining the apparent rhetoric unanimity that defined the agenda of the mobilization around the Social Determinants of Health, we seek to address the differences between these approaches and conclude that the Social Determinants of Health approach marks an important but incomplete advance in the mobilization towards the reduction of health inequities.

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          Most cited references36

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          Theories for social epidemiology in the 21st century: an ecosocial perspective.

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            THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE1

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              Inequality in income and mortality in the United States: analysis of mortality and potential pathways.

              To examine the relation between health outcomes and the equality with which income is distributed in the United States. The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. Age adjusted mortality from all causes. There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                sdeb
                Saúde em Debate
                Saúde debate
                Centro Brasileiro de Estudos de Saúde (Rio de Janeiro )
                2358-2898
                September 2015
                : 39
                : 106
                : 841-854
                Affiliations
                [1 ] Fundação Oswaldo Cruz Brazil
                [2 ] Universidad Nacional de Colombia Colombia
                [3 ] Fundação Oswaldo Cruz Brazil
                Article
                S0103-11042015000300841
                10.1590/0103-1104201510600030023
                d06598ed-528d-49c3-928f-ccdc6dcd9d91

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0103-1104&lng=en
                Categories
                HEALTH CARE SCIENCES & SERVICES
                HEALTH POLICY & SERVICES

                Health & Social care,Public health
                DESIGUALDADES EM SAÚDE,INEQUALITIES IN HEALTH,Equity in health,Social medicine,Equidade em saúde,Medicina social

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