Determinants of Quality in Health Care

Determinants of Quality in Health Care

Introduction

Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health has recently been given new force in the fight against health inequity. The health care sector is a vital determinant of health in itself and a key resource in improving health in an equitable manner. Actors in the health care sector must recognize and reverse the sector's propensity to generate health inequity. The sector must also strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.

The production of better population health outcomes is usually equated with improvements in health care. But this is a somewhat crude equation. All too often, health care sectors, firmly rooted in medicine, do not demonstrate active engagement with the wide determinants of patients' health; do not ensure, through a nuanced understanding of social determinants, that care services are made available and accessible to all social groups equitably; and have not been as proactive as one might expect, given the evidence on social determinants of health, in engaging and working with other government sectors (as a kind of steward in support of those sectors' own activities) to ensure that all government entities appreciate their potential to affect health and health equity (Wilkins 2002).

10 determinants of quality in health care in America

Bias Toward Curative Medicine

The compact of medical, political, commercial, and popular dedication to curative medicine is reflected in health care spending trends in the member countries of the Organisation for Economic Co-operation and Development (OECD). In 2006, the vast majority of these countries spent between 8% and 10.5% of their gross domestic product on health care (excluding the United States, which spent 15.3% of its gross domestic product on health care). Thirty years ago, the same OECD countries were spending between 5% and 7%.[ 43] The extent of these spending increases and the often relatively small health gains spread unevenly across groups compounded by the recognition of escalating health care costs to come with the growing burden of chronic disease in poor countries — raise the question of the sustainability of the biomedical model.

Changing the medical imagination requires a grasp of the way that risk factors work in populations and the potential for action on social determinants to improve population-scale health (Esping-Andersen 1999).

A Reoriented Health Care Sector

Earlier we asked what a health care sector reoriented toward action on the social determinants of health, with health equity as a central goal, would look like. The box on the next page summarizes the characteristics of such a reorganized health care sector, and a number of these characteristics are discussed in the sections to follow.

It is notable that action on social determinants of health implies both the leadership of the health care sector ...