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Open Access Highly Accessed Research article

Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

Paul R Ward1*, Samantha B Meyer1, Fiona Verity2, Tiffany K Gill3 and Tini CN Luong1

Author Affiliations

1 Discipline of Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, 5042, Australia

2 Department of Social Work and Social Planning, Flinders University, Sturt Road, Bedford Park, Adelaide, 5042, Australia

3 Population Research & Outcome Studies, Discipline of Medicine, University of Adelaide, 122 Frome Street, Adelaide, 5000, Australia

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BMC Public Health 2011, 11:630  doi:10.1186/1471-2458-11-630

Published: 5 August 2011

Abstract

Background

In order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH) called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH) (e.g. social capital, empowerment, social inclusion). However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory.

Methods

Data were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted.

Results

Statistical analysis revealed that people on lower incomes (less than $45000) experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion), higher levels of discrimination and less political action (lower social inclusion) and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion) and engaging in more political action (higher social empowerment). In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion).

Conclusions

Applying social quality theory allows researchers and policy makers to measure and respond to the multiple sources of oppression and advantage experienced by certain population groups, and to monitor the effectiveness of interventions over time.