Activism to Modify the Social Determinants of Health: The Role of Evaluation

While mainstream public health has recognized the prime role of social determinants of health (SDOH) in shaping patterns of health and disease, the field has struggled to find meaningful ways to tackle these fundamental causes of health and health inequities. Though often overlooked within the field of public health, activist campaigns have been a vital force for securing advances in confronting and modifying SDOH, from obtaining wage increases to expanding reproductive health care to securing health care for millions through the expansion of Medicaid. These examples show that social movement activism can encourage public officials to make tackling the SDOH a priority on their policy agendas and contribute to reducing the influence of the special interests who often oppose these changes. To integrate activism with public health practice more consistently, researchers, practitioners, and activists need a robust body of evidence that enables them to leverage activism to address social determinants. This narrative review seeks to explore the role that evaluation can play in strengthening health activism aimed at SDOH and making it a more accepted and familiar component of public health practice. We offer definitions of several key terms, review relevant literature on evaluation of health activism, and propose guiding questions along with real-life examples of corresponding evaluations. We aim to encourage public health practitioners to recognize the role of activism in advancing public health and to find ways to use evaluation to partner with activist campaigns seeking to modify SDOH.