Social determinants of health inequalities: moving toward a socio-constructivist model supported by information and communication technologies

Abstract

There is a proven connection between an individual's social condition and his/her life expectancy and likelihood of contracting diseases. Indeed, a large body of scientific evidence shows that social inequalities, in particular, are the main “cause” of harm to health. The interpretation provided by the theory of specific determinants, according to which health inequalities are caused by lifestyles and a propensity for unhealthy behaviors, has contributed greatly to focusing scholars’ attention on social contexts, believed to influence an individual's inclination/exposure to risk, and therefore, health inequalities. Nevertheless, the theory of the social determinants of health provides a very rigid representation of the factors responsible for health, which are placed in categories with varying levels of centrality. In short, the theory sets out a hierarchy that goes from the general to the particular, with the more external layers (socio-cultural conditions and environmental context) influencing the internal layers (genetic and biological factors), but not vice versa. Reciprocal influences among the factors are excluded, as are interactions among the processes that put subjects at risk or protect them. The adopted explicative model is linear, reductionist, and based on a cause-and-effect relationship. However, today we know that interactions between the body, individual, and society are difficult to reconcile with a deterministic view of social inequalities in health; hence, there appears to be an urgent need to formulate hypotheses and develop approaches based on complex strategies regarding the construction of reality. This article sets out a pathway that, starting from the theory of the social determinants of health, goes on to show the necessity of a socio-constructivist approach supported by information and communication technologies. Moreover, it outlines the preconditions of a culture – and communication-based intervention model that can aid institutions in making choices in the field of social architecture that can reduce health inequalities.