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Vol. 21. Num. 3. 2012. Pages 331-341

Ethnicity, Migration and the 'Social Determinants of Health' Agenda

[Etnicidad, Migración y la Agenda de los "Determinantes Sociales de la Salud"]

Ingleby, David

University of Amsterdam, The Netherlands

Abstract

One of the most promising recent developments in health policy has been the emergence of a global 'health equity' movement concerned with the social determinants of health. In European research and policy-making, however, there is an strong tendency to reduce 'social determinants' to 'socioeconomic determinants' and to ignore the role of ethnicity, migration and other factors in the creation of inequities. This threatens to hold up the development of work on ethnicity and migration and thus to perpetuate inequities linked to these factors. The present article sets out to illustrate this tendency and to investigate the reasons which may underlie it. The justifications often put forward for neglecting ethnicity and migration are shown to be erroneous. An integrated approach, simultaneously taking account of socioeconomic status, migration and ethnicity as well as other determinants of inequity, is essential if work on the social determinants of health is to make progress. Equity is indivisible; researchers investigating different aspects of social stratification should not treat each other as rivals, but as indispensible allies. An integrated, intersectional, multivariate and multilevel approach will improve our understanding of health inequities and make available more resources for tackling them.

Resumen

Uno de los avances recientes más prometedores en política sanitaria ha sido la aparición de un movimiento global por la "igualdad sanitaria" que aborda los determinantes sociales de la salud. Sin embargo, en la investigación y legislación europeas hay una fuerte tendencia a reducir los "determinantes sociales" a "determinantes socioeconómicos" pasando por alto de esta forma el papel que juegan la etnicidad, la migración y otros factores que contribuyen a la aparición de desigualdades. Este hecho supone una amenaza para el desarrollo de estudios sobre etnicidad y migración, perpetuándose de esta manera las desigualdades asociadas a estos factores. El presente artículo tiene como objetivo describir esta tendencia y analizar las razones subyacentes. Las justificaciones que con frecuencia se aducen por este descuido de la etnicidad y la inmigración han demostrado ser erróneas. Un enfoque integrado que tenga en cuenta simultáneamente el nivel socioeconómico, la migración y la etnicidad, así como otros factores determinantes de desigualdad, es esencial si se pretende avanzar en la investigación sobre los factores determinantes de salud. La igualdad es indivisible; los investigadores que estudian distintos aspectos de la estratificación social no deberían considerarse mutuamente como rivales, sino como aliados indispensables. Un enfoque integrado, intersectorial, multivariado y multinivel ampliará nuestros conocimientos sobre las desigualdades sanitarias y posibilitará que se empleen más recursos para abordarlas.

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