Question

Write a policy brief on the Social Determinants of health

Identify issue.

Background information - (a) Population effected; (b) Local, state or national level; and (c) Evidence about the issues supported by resources

Problem statement.

Suggestions for addressing the issue (solutions) - (a) Including necessary stakeholders (government officials, administrator); and (b) Include budget or funding considerations, if applicable

Impact on the Health Care Delivery System

Include three peer-reviewed sources and two other sources to support the policy brief

Answer 1

The social determinants of health (SDH) are the conditions in which people are born, grow, live, work and age, including the health system. The social determinants of health are mostly responsible for health inequities the unfair and avoidable differences in health status seen between countries as well as within countries between more and less advantaged social groups. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Health inequities put vulnerable groups at further disadvantage, thus diminishing opportunities to be healthy.

Global health presents an interdisciplinary set of challenges that transcend national boundaries. Global health is not “foreign health,” “international health,” or “health of the poor.” Rather, global health refers to the health of all populations in the world, regardless of nation state, geographical position, or stage of development. The defining characteristic that makes global health “global,” however, is its central concern with the interconnectedness among populations, the transfer of health risks across national borders, and the consequences of globalization on evolving patterns of health, disease, and social determinants. It includes an interdisciplinary set of challenges involving health determinants (social, political, economic), collections of health problems, and the societal responses to both. Global health is inclusive of population-level policies as well as individual approaches to health promotion and pays special attention to the needs of the most vulnerable populations.

Global health knowledge depends on an understanding of the principal health problems of different populations, ranging from their physiological basis to their epidemiological context. Because global health challenges are diverse and interdisciplinary, information from the basic sciences, applied life sciences, and social sciences—including economics, biostatistics, and demography—is all critical to learn about health conditions that result from a world that is becoming ever more interdependent. Some of the most fundamental challenges in global health relate to (1) an unfinished agenda of infections, malnutrition, maternalchild health problems, (2) the rise of non-communicable diseases and injuries, and (3) emerging health risks that transcend national boundaries. To understand these challenges, it is important to study patterns of global morbidity and mortality; identify determinants that contribute to health inequalities; and discuss both the challenges and responsibility to provide health services to the most vulnerable, including populations of failed or fragile states, refugees, and victims of humanitarian crises and human rights violations. Essential in the study of global health are the rigorous methods for measuring population health; the analytic tools necessary for decision making; and the evidence base for the effectiveness, risks, and costs of interventions, ranging from individual health services to population-based instruments of policy. Case studies and comparative exercises can help you to confront ethical challenges associated with priority setting, learn how real world policy is critically influenced by cultural norms, systemic factors, health system capacity, and the economic, social, and political climate, and consider the complex process of how knowledge is translated to evidence-based policy.

Knowledge produced through research must be translated into understandable, accessible, and relevant evidence that can be used by decision makers to mobilize resources, formulate policy, implement programs, and evaluate impact. However, shortcomings found in the translation process mean that evidence is not always utilized as effectively as it could be. Indeed, research findings are often not synthesized, packaged, or contextualized for those very audiences that
could have the largest benefit. The resulting discontinuity between research and action is sometimes referred to as the “knowledge action gap.”

Written communication skills are a key component of effective knowledge translation and a critical tool for successfully meeting global health challenges. Knowledge translation is a process that brings together the often disparate realms of research and action to ensure that health practices, behaviors, and policies are based on reliable evidence. The concept of knowledge translation includes more than the simple handing off of evidence from the researcher to the end user, a process that is sometimes termed “dissemination.” Rather, knowledge translation involves refining or transforming evidence to make it comprehensible and meaningful for the recipient who will be reviewing and/or implementing it. This process requires not only selecting specific information but also organizing and packaging it in ways that vary with both the creator’s intentions and the audience’s needs. Effective knowledge translation therefore requires communication and partnerships between researchers and key stakeholders who must understand and use the research; these various audiences include policymakers, health care practitioners, journalists, administrators, and the general public.

Framework for Analyzing Policy Choices
An obvious prerequisite to effective translation and communication about global health challenges is a comprehensive understanding of the problem and an analysis of the policy choices. However, contemporary global health problems are generally complex, interdisciplinary, and dependent on context. A rubric can be a helpful tool to guide a systematic approach to identifying the elements of the problem, ensuring that the many kinds of information required for the analysis have been considered, and that the process for comparing different options is comprehensive in its scope. Accurate analysis must consist of the following five-step framework:

1. Establishing the context. Who are the stakeholders, decision makers, influential actors? What is the nature of the problem and the decision or policy choice that needs to be made? What are the contextual factors included in the case that would be important to consider?
2. Laying out the alternatives. What are the realistic and feasible options? What information is needed about the different options or strategies? What are the attributes of each alternative? Are there obvious tradeoffs? What is the timing of the decision and the implementation of the policy choices?
3. Predicting the consequences. Given the information about each alternative or strategy described above, what would the expected outcomes be for each of the choices? Which will be most effective? Would subpopulations differentially benefit? (e.g., rural versus urban, children versus adults, etc.)
4. Valuing the outcomes. What are the decision making criteria—meaning what outcomes are valued by the decision maker or stakeholders (e.g., improving health, reducing risk, promoting equity, preferential protection of the poorest, etc.)
5. Making a choice. Formulate a recommendation based on the systematic process. Where are the key uncertainties? Which factors were most influential? Where would you have liked better information? Would you have made the same recommendation if the context significantly changed, for example a different setting?

Employing a framework such as this will aid both you and your intended audience, whose comprehension of the subject matter will be enhanced by a well-defined methodology. Each step follows from the preceding one, and while your specific goal may require the use of only one—for instance, describing the current circumstances of an epidemic may only require the first step—for an analysis, you cannot remove any steps. For instance, any value you place on potential policy choices will be weakened if you have not previously summarized all the options available. Likewise, you cannot
predict the consequences of an action without a complete understanding of its contextualized background.

Communication Tools
There are a range of print tools routinely used to translate knowledge about global health, including, but not limited to, research articles, editorials, fact sheets, and policy briefs. Each of these tools has a distinctive format and style, but every one of them, correctly applied, serves a critical function in conveying global health information to a variety of audiences.
Choosing which tool to apply to convey a given message is not determined by the issue itself but by the underlying objective, message, motivation, and target audience. Knowing the audience—and why they are being targeted—is key not only to selecting an appropriate communication tool, but also to ensuring that the document successfully communicates the message. As the accompanying box suggests, the target audience may consist of policy makers, technical or disciplinary experts, practitioners, or the public. Technical experts are much more likely reached using a research article than a fact sheet. On the other hand, for the public, a fact sheet could be an excellent choice, while a research article is likely to leave the message unheard.

Building Skills to Write a Policy Brief
Policy briefs about global health topics may vary in their format and content. For the purpose of this writing guide, we will focus on those which start by introducing a specific policy issue and address the following general purposes:
1. Convince a specific audience that a problem matters;
2. Clearly present a set of available and feasible options to address that problem;
3. Cogently argue for and against these options; and
4. Make specific recommendations to motivate action to address the problem.
A policy brief can be challenging to write as it must be concisely written but also carefully constructed so that each section flows logically into the next, and because it should be based on accurate information and high-quality evidence drawn from a variety of disciplines. The following are the typical components of an effective policy brief: title, executive summary, delineation of the problem, description of the options, analysis of the options, recommendation, and, sometimes, addenda such as references or recommended reading.