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Who, and what, causes health inequities? Reflections on emerging debates from an exploratory Latin American/North American workshop
  1. Nancy Krieger1,
  2. Margarita Alegría2,
  3. Naomar Almeida-Filho3,
  4. Jarbas Barbosa da Silva4,
  5. Maurício L Barreto5,
  6. Jason Beckfield6,
  7. Lisa Berkman7,
  8. Anne-Emanuelle Birn8,
  9. Bruce B Duncan9,
  10. Saul Franco10,
  11. Dolores Acevedo Garcia11,
  12. Sofia Gruskin12,
  13. Sherman A James13,
  14. Asa Christina Laurell14,
  15. Maria Inês Schmidt15,
  16. Karina L Walters16
  1. 1Department of Society, Human, Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Department of Psychiatry, Harvard Medical, School, Boston, Massachusetts, USA
  3. 3Universidade Federal Da, Bahia (UFBA) and Professor of Epidemiology and Director, Instituto De Saude, Coletiva, UFBA, Bahia, Brazil
  4. 4Health Surveillance and Disease Management, Pan American Health Organization, Washington, DC, USA
  5. 5Department of Epidemiology, Universidade, Federal da Bahia Instituto de Saude Coletiva, Salvador, Brazil
  6. 6Department of Sociology, Harvard, University, Cambridge, Massachusetts, USA
  7. 7Harvard Center for Population Studies and Development, Harvard University, Cambridge, MA, and Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA
  8. 8Department of International Development, Studies and Canada Research Chair in International Health, University of Toronto, Toronto, Canada
  9. 9Department of Social Medicine, Graduate, Studies Program in Epidemiology, School of Medicine, Federal University of Rio, Grande do Sul, Porto Alegre, RS, Brazil
  10. 10Doctorado Interfacultades en Salud Pública, Universidad Nacional de Colombia, Bogatá, Colombia
  11. 11Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
  12. 12Department of Global Health and Population; Director, Program on International Health and Human Rights, Harvard School of Public Health, Boston, Massachusetts, USA
  13. 13Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
  14. 14Department of Health of the Legitimate, Government of Mexico, Mexico City, Mexico
  15. 15Department of Social Medicine, Graduate Studies Program in Epidemiology, School of Medicine, Federal, University of Rio Grande do Sul, Porto Alegre, RS, Brazil
  16. 16William P. and Ruth Gerberding University, Professorship, University of Washington, School of Social Work, and Indigenous, Wellness Research Institute, Seattle, Washington, USA
  1. Correspondence to Professor Nancy Krieger, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 717, Boston, MA 02115, USA; nkrieger{at}hsph.harvard.edu

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Rapidly rising interest—from national and international health organisations, governments, civil society, the private sector and myriad academic disciplines—in what has become known as the ‘social determinants of health’1 2 is welcome to the many, in and outside of public health, who have long held that issues of social justice and the public's health are inextricably linked (box 1).2 3 As inevitably happens, however, when an issue gets ‘mainstreamed’, a multiplicity of disparate voices enter the discussion, informed by not only different disciplinary vantages, but also divergent values, priorities and politics.

Box 1 Political, historical, intellectual and economic context of a Latin American/North American discussion about societal determinants of between-country and within-country health inequities

Political, historical, and intellectual context

Explicit efforts to develop theories articulating the causal connections between political economy, social injustice and health inequities can readily be traced back to the mid-19th century.2–8 Examples include the European writings of Rudolf Virchow (1821–1902) and Friedrich Engels (1820–1895) in the 1840s, as linked to societal upheavals spurred by the rise of industrial capitalism, along with their subsequent elaborations in the early 20th century by European, North American and Latin American analysts and politicians, such as Chilean president Salvador Allende (1908–1973), variously concerned with the health impact of political and economic systems, and political and economic injustice, both within and across nations and regions.2–6 More recent antecedents include: A. the rise of critical science frameworks during the 1960s and 1970s, including within the health fields, as spurred by post-World War II national liberation and anti-imperialist movements along with the emergence of worldwide social movements regarding racism, indigenous rights, gender, sexuality, human rights and the environment (ecology), and B. since the mid-1990s, a renewed round of theorising …

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