Friedli

Mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual solutions. A focus on collective efficacy, as well as personal efficacy is required. A preoccupation with individual symptoms may lead to a ‘disembodied psychology’ which separates what goes on inside people’s heads from social structure and context. How things are done (values and culture) and how things are distributed (economic and fiscal policy) are the key domains that influence and are influenced by how people think, feel and relate. Mental health promotion has made and continues to make a significant contribution to our understanding of the wider determinants of health and the crucial relationship between social position and emotion, cognition and social function or relatedness. What difference does it make if discomfort and difficulties are shared by everyone? These questions lie at the heart of current debates about the social determinants of health, the relative contribution of material, psycho-social and biological factors and the effects of inequalities (Lynch et al 2000; Wilkinson and Pickett 2006; Dahlgren and Whitehead 2006).5

Dr Lynne Friedli

The CSDH is concerned with the link between health and position in the social hierarchy and the role of stratification. It sees the axes of social stratification as socio/economic, political and cultural and identifies three key domains for action/empowerment: material requisites, psycho-social (control over lives) and political voice (participation in decision making). At the heart of the report is the view that achieving a more equitable distribution of power requires collective social action.

Dr Lynne Friedli

The CSDH is concerned with the link between health and position in the social hierarchy and the role of stratification. It sees the axes of social stratification as socio/economic, political and cultural and identifies three key domains for action/empowerment: • material requisites • psycho-social (control over lives) • political voice (participation in decision making) At the heart of the report is the view that achieving a more equitable distribution of power requires collective social action.

Dr Lynne Friedli

Socio economic position (SEP) refers to the position of individuals in the hierarchy and is inherently unequal, shaping access to resources and every aspect of experience in the home, neighbourhood and workplace. SEP structures individual and collective experiences of dominance, hierarchy, isolation, support and inclusion. Social position also influences constructs like identity and social status, which impact on wellbeing, for example, through the effects of low self esteem, shame, disrespect and ‘invidious comparison’.

Dr Lynne Friedli