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      A saúde e seus determinantes sociais Translated title: Health and its social determinants

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          Abstract

          Este artigo busca analisar as relações entre saúde e seus determinantes sociais, apresentando inicialmente o conceito de determinantes sociais de saúde (DSS) e uma breve evolução histórica dos diversos paradigmas explicativos do processo saúde/doença no âmbito das sociedades, desde meados do século XIX. Em seguida são discutidos os principais avanços e desafios no estudo dos DSS, com ênfase em novos enfoques e marcos de referência explicativos das relações ente os diversos níveis de DSS e a situação de saúde. Com base nesses estudos e marcos explicativos, discute-se, em seguida, uma série de possibilidades de intervenções de políticas e programas voltados para o combate às iniqüidades de saúde geradas pelos DSS. Finalmente, são apresentados os objetivos, linhas de atuação e principais atividades da Comissão Nacional sobre Determinantes Sociais da Saúde, criada em março de 2006, com o objetivo de promover estudos sobre os DSS, recomendar políticas para a promoção da eqüidade em saúde e mobilizar setores da sociedade para o debate e posicionamento em torno dos DSS e do enfrentamento das iniqüidades de saúde.

          Translated abstract

          This article aims to analyze the relationships between health and its social determinants, initially presenting the concept of Social Determinants of Health (SDH) and the historical evolution of paradigms that account for the health/disease process at societal level since mid-1800's. The main advances and challenges in the study of SDH are presented with emphasis on the new approaches and frameworks to explain the complex relationships between the various levels of SDH and health outcomes. Based on these frameworks, some entry points for interventions on SDH and types of policies and programs to tackle health inequities are explored. Finally, the article presents the objectives, lines of actions and main activities developed by the National Commission on Social Determinants of Health, created in March 2005 to promote studies on SDH, to recommend policies for promotion of health equity and to mobilize sectors in society to promote awareness about the importance of SDH and the fight against health inequities.

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          Most cited references 19

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          Social capital, income inequality, and mortality.

          Recent studies have demonstrated that income inequality is related to mortality rates. It was hypothesized, in this study, that income inequality is related to reduction in social cohesion and that disinvestment in social capital is in turn associated with increased mortality. In this cross-sectional ecologic study based on data from 39 states, social capital was measured by weighted responses to two items from the General Social Survey: per capita density of membership in voluntary groups in each state and level of social trust, as gauged by the proportion of residents in each state who believed that people could be trusted. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state. Income inequality was strongly correlated with both per capita group membership (r = -.46) and lack of social trust (r = .76). In turn, both social trust and group membership were associated with total mortality, as well as rates of death from coronary heart disease, malignant neoplasms, and infant mortality. These data support the notion that income inequality leads to increased mortality via disinvestment in social capital.
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            The Strategy of Preventive Medicine

             G. ROSE,  G Rose,  G Rose (1992)
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              A glossary for social epidemiology.

               John Krieger (2001)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                physis
                Physis: Revista de Saúde Coletiva
                Physis
                IMS-UERJ (Rio de Janeiro )
                1809-4481
                April 2007
                : 17
                : 1
                : 77-93
                Affiliations
                [1 ] Fundação Oswaldo Cruz
                [2 ] Academia Nacional de Medicina Brazil
                [3 ] Comissão Nacional sobre Determinantes Sociais da Saúde
                Article
                S0103-73312007000100006
                10.1590/S0103-73312007000100006
                Product
                Product Information: website
                Categories
                PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

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