Social determinants of health in countries in conflict - What is GIS ...

Chapter 5
A social determinants approach to the
health impact of conflict
5.1 Major social determinants in conflict settings
The two major structural determinants, reflecting the character of armed conflict in
the twenty-first century, are the loss of human rights and breaches of medical neutrality.
A major intermediate determinant is psychosocial distress resulting from the structural
determinants, expressed in terms of a final health outcome—mental health problems.
Thematic areas can be explored as guides to action and interventions (see Box 1).
The loss of human rights
The loss of human rights is the first and most important of the major social
determinants in conflict settings. Human rights losses are also similar to those
characteristics that identify a “humanitarian crisis” that requires international
intervention (see Section 3.1). The right to live in dignity and security are enshrined in
UN conventions and protocols. They are, as Amartya Sen reminds us, primarily ethical
demands that make claims on individuals and organizations that are capable of taking
action to guarantee such rights.
Box 1. Social determinants of health in conflict settings
Structural determinants include:
• the loss of human rights which are usually addressed during emergency
responses but which also need to be addressed in the long term through building
up capacities;
• breaches of medical neutrality which require national and international action
and the involvement of nongovernmental organizations.
Intermediate determinants include:
• stress, distress and disease: tackling mental health problems in the social
setting rather than through individual counselling.
Thematic areas as guides to action include:
• vulnerable groups: everyone is vulnerable;
• loss of livelihood;
• loss of community support and social networks;
• provision of, and access to, health services.
SDH-chapters-countries in conflict-7 Oct.indd 26 08/10/2008 14:24:50