Session 8: Social Determinants of Health

Guest speaker: Anousheh Marouzi (Pharm.D., M.Sc., Community Health and Epidemiology Department, University of Saskatchewan)

NOVEMBER 3rd, 2022


Understanding the underlying causes of health inequity is imperative to devise policies to combat these inequities. It is well documented in the literature that health inequities result from different conditions in which one grows, works, and lives. Wealthy individuals, for example, live and work in better circumstances and therefore enjoy better health compared to low-income individuals. These circumstances have come to be known as the social determinants of health and include income and wealth, educational attainment, employment, race and ethnicity, gender, and social and physical environment, among others. In this presentation, I will first speak about the theories of social production of health and diseases while noting the social determinants of health. Further, I will discuss the impacts of economic sanctions on population health, adopting an equity lens. And in the end, I will try to raise a question to relate my presentation to what is currently happening in Iran.

Suggested reading before the meeting 

Meeting report

One’s health status is a social reality. This might sound like a counter-intuitive claim, given that we tend to understand one’s health status in biological terms. Nonetheless, there are numerous social factors that shape one’s biological condition. Think about, for example, one’s economic status or even one’s gender or race. Anousheh gave us a detailed survey of the body of empirical evidence showing that such social factors, at least in part, determine one’s health status. If so, those policies the implementation of which affects the social determinants of health can be the subject of appraisal from the standpoint of health policy and its ethical aspects. Anousheh in particular, gave us the example of economic sanctions on Iran. She argued that although sanctions do not directly target the health sector of Iran’s society, they have significant negative effects on people’s health status because of the way they affect the social determinants of health.

In the Q&A section, Anousheh was asked about whether it is the nature of sanctions per se or it is the way that Iran’s government deals with those sanctions through its managerial system that brings about the negative impact we get in the health sector. Anousheh showed us that it is difficult to disentangle the two factors. Nonetheless, as she put it, having a corrupted economic-political system (such as the one we see in Iran) makes a significant negative effect on how the sanctions are felt by people who are in need of health care. The audience also raised questions about the possible method of appraisal of economic sanctions from the standpoint of health inequity. Anousheh walked us through the basics of health inequity and illustrated her view with an example. She argued that the sanctions, in their current form, bring more pressure on people with poor economic status. Sanctions can be appraised by whether they cause trouble for people’s health in a uniform or non-uniform way.

Anousheh started her career as a pharmacist in Iran. Her academic interests then gradually turned toward health policy and the topic of economic sanctions, among others. She told us about what she saw and experienced as a pharmacist during the time that Iran’s economy was sanctioned: high prices, drug shortages, and the difficulty of poor people getting access to their needs. This led her to think about the ethical aspects of policies that affect the health sector. As a result, she eventually started to train herself in the relevant areas to make her own contributions to the field of health policy. All this speaks in favor of her down-to-earth approach to addressing what the problems are and how they ought to be solved. Anousheh is a good example for those who want to know what it is to make this world a better place to live for everyone. Her future is bright, and so is ours.