Synergy for health equity: integrating health promotion and social determinants of health approaches in and beyond the Americas / Sinergia para la equidad en salud: integración de los enfoques de la promoción de la salud y de los determinantes sociales de la salud dentro y fuera de la región de las Américas

Health promotion and social determinants of health approaches, when integrated, can better contribute to understanding and addressing health inequities. Yet, they have typically been pursued as two solitudes. This paper presents the key elements, principles, actions, and potential synergies of these complementary frameworks for addressing health equity. The value-added of integrating these two approaches is illustrated by three examples drawn from the authors' experiences in the Americas: at the community level, through a community-based coalition for reducing chronic disease disparities among minorities in an urban center in the United States; at the national level, through healthy-settings interventions in Canada; and at the Regional level, through health cooperation based on social justice values in Latin America. Challenges to integrating health promotion and social determinants of health approaches in the Americas are also discussed.

Los enfoques de la promoción de la salud y de los determinantes sociales de la salud, cuando se integran, pueden contribuir mejor a la comprensión y el abordaje de las inequidades en salud. No obstante, normalmente se han aplicado como dos cuestiones separadas. En este artículo se presentan los elementos clave, los principios, las acciones y las posibles sinergias de estos marcos complementarios para abordar la equidad en salud. El valor añadido de la integración de estos dos enfoques se ilustra mediante tres ejemplos extraídos de las experiencias de los autores en la Región de las Américas: a nivel de la comunidad, mediante una coalición comunitaria dirigida a reducir las disparidades en relación con las enfermedades crónicas entre las minorías de un centro urbano de los Estados Unidos; a escala nacional, mediante las intervenciones de promoción de entornos saludables en Canadá; y a nivel regional, mediante la cooperación en salud basada en los valores de la justicia social en América Latina. También se analizan las dificultades que entraña integrar los enfoques de la promoción de la salud y de los determinantes sociales de la salud en la Región de las Américas.

The ecology of health services utilization in Grenada, West Indies

Few empirical investigations into the nature of health services utilization fully acknowledge that the home environment may act as a socio-geographical focus of both disease transmission and of learned health behaviour. This paper examines the role of the home environment, as well as of personal characteristics and accessibility, in the utilization of health services in Grenada, West Indies. Bivarite and logit analysis of household survey data are employed to identify markers of high user individuals and households. Aspects of each domain of the home environment (physical and behavioral environment, demographies, and residential mobility) emerge as contributors to the utilization phenomenon in the study communities. Both etiological and socio-economic linkages are postulated to underlie the observed relationships. The implications of this work for health planning in developing countries is discussed. (AU)

Reported versus recorded health service utilization in Grenada, West Indies

Calls for household surveys to provide information on service utilization in less developed countries raise questions regarding the accuracy and reliability of reporting. This paper compares reported to recorded health service utilization for diarrhoea and any other morbidity over a 2-week and 3-month period for information obtained from a household survey in Grenada, West Indies. A sensitivity analysis is used to derive minimum and maximum estimates of the accuracy of reported utilization. Over-reporting utilization was found to be between 33 and 62 percent for diarrhoea and 49 and 81 percent for any other morbidity. Under-reporting of all utilization was estimated to be between 47 and 65 percent. These results cast doubt on the utility of household surveys as a reliable source of information regarding service utilization. (AU)