Diagnosing social ills: Theorising social determinants of health as a diagnostic category.

Publisher: Blackwell Publishing Country of Publication: England NLM ID: 8205036 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1467-9566 (Electronic) Linking ISSN: 01419889 NLM ISO Abbreviation: Sociol Health Illn Subsets: MEDLINE

Publication: <2003->: Oxford ; Malden, MA : Blackwell Publishing
Original Publication: Henley-on-Thames ; Boston, Mass. : Routledge & Kegan Paul,

Social Determinants of Health* ; Social Factors*; Humans ; United States ; Poverty ; Unemployment

Medicine, as an institution and discipline, has embraced social determinants of health as a key influence on clinical practice and care. Beyond simply acknowledging their importance, most recent versions of the International Classification of Diseases explicitly codify social determinants as a viable diagnostic category. This diagnostic shift is noteworthy in the United States, where 'Z-codes' were introduced to facilitate the documentation of illiteracy, unemployment, poverty and other social factors impacting health. Z-codes hold promise in addressing patients' social needs, but there are likely consequences to medicalising social determinants. In turn, this article provides a critical appraisal of Z-codes, focussing on the role of diagnoses as both constructive and counterproductive sources of legitimacy, knowledge and responsibility in our collective understanding of health. Diagnosis codes for social determinants are powerful bureaucratic tools for framing and responding to psychosocial risks commensurate with biophysiological symptoms; however, they potentially reinforce beliefs about the centrality of individuals for addressing poor health at the population level. I contend that Z-codes demonstrate the limited capacity of diagnoses to capture the complex individual and social aetiology of health, and that sociology benefits from looking further 'upstream' to identify the structural forces constraining the scope and utility of diagnoses.
(© 2023 Foundation for the Sociology of Health & Illness.)

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P2CHD042849 Eunice Kennedy Shriver National Institute of Child Health and Human Development

Keywords: USA; inequalities; medical knowledge; medical practice; social determinants of health; social systems

Date Created: 20230207 Date Completed: 20240320 Latest Revision: 20240320

20240320

10.1111/1467-9566.13623

36748959