Östlin et al in PLoS, November 2011


Reviewed by Karen Pesse

This article presents a very interesting “list” of research priorities in order to tackle current situations associated with inequity and the persistence of social determination of (bad) health. In doing so it also can be read as a sort of “general diagnose”, based on the report of the Commission of Social Determinants of Health and other important international declarations and agreements, of the existing  problems in this field.

Although quite schematic and, at least to my understanding, slightly biased by the wishful thinking of the authors , the initial presentation of the “paradigm shift” in health research is thought-provoking, and would be worth opening a discussion forum. The box presenting the new research strategies and methodologies characteristics could be a good starting point for this debate.

Four overreaching themes are presented and discussed as research priorities: 1) global factors and processes that affects health equity; 2) structures and processes that differentially affect people´s chances to be healthy; 3) health services and health factors that influence health equity; and 4) the very interesting issue on effective policy intervention to reduce health inequities (or as mentioned in the article: to change from a “problem space” to a “solution space” paradigm). This agenda demonstrates once again the importance of a wide and trans-disciplinary approach in the area of health research, and the prominence of issues regarding socio- political features more than technical or even biological aspects. At the same time, it stressed the need to answer a whole amount of questions posed by the organization of health (care) services, in particular those regarding the so called “new tendencies”, such market orientation, decentralization, innovative financing mechanisms, etc.

As the article was written by a large team of (mostly well know) public health and policy researchers, it can be assumed that the list of priorities was elaborated simply by putting together all their points of views on this issue. For that matter, a detailed description on how these priorities were identified and agreed upon, would have been an important plus for the quality and validity of this paper.


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