The social determinants of health: how can a radical agenda be mainstreamed?

The social justice framing within the WHO Commission's Report on the Social Determinants of Health is vital. Yet it can too easily be dismissed as ideology and an unfit justification for major change. Although the general public acknowledges that structural factors, such as poverty, can affect health, they tend to see personal health behaviours as the strongest determinants of health, mirroring the main focus of health providers in recent decades. Thus a social reform agenda, while being an integral part of public health history, is nowadays too often seen as remote from the essential core of work in health. Translating the Commission's agenda into action therefore requires a recalibration of our entire health system, starting with an understanding of how complex issues can be framed in ways that inspire action, endorse mutuality of interests and enhance the perceived efficacy of the solutions, among the myriad of actors in position to make the reduction of health inequities succeed or fail. A sophisticated discourse analysis and/or communications research agenda could help to move us forward. It involves understanding and reframing the way politicians, policy-makers, practitioners and the public see "the problem" and reframing the potential of many roles in "the solution".