Exploring Human Rights-Based Activism as a Social Determinant of Health: Insights from Brazil and South Africa

Social determinants of health (SDH) are usually understood as circumstances and structures that disadvantage individuals by increasing their vulnerability to disease and injury. In this model social determinants of health act upon individuals and communities who are relatively powerless to react against the health impacts of factors such as poverty and marginalization. With the aim of expanding the concept of social determinants, we examine the role human rights-based activism can play in improving health outcomes by exploring two well-known cases: activism through Brazil's National Health Council, and HIV activism by South Africa's Treatment Action Campaign (TAC). Drawing on these cases we argue that, in addition to the valuable current and historical conceptions of social determinants of health as contextual factors that act upon people, social determinants can and should also be understood as processes of participation and engagement whereby individuals are able, through their own knowledge and actions, to improve health outcomes for themselves and others. Building on a phrase proposed by Heywood, we posit that human rights-based activism can be an influential agency-based social determinant of health.