It’s not only about alcohol

Understanding how social determinants of health are a key part of FASD prevention

A while back, I blogged about a fascinating report published by the Robert Wood Johnson Foundation called “A New Way to Talk About the Social Determinants of Health” (see this post here). The report made me realize that I mentioned the term “social determinants of health” pretty much every day as a regular part of conversation, but that most people (i.e., everyone but the top 10 people I work with) really don’t use the term and probably had only a vague idea of what I was talking about.

Well, I’ve been trying to reform since then and use other terms and phrases. Basically, I’ve been trying to find alternate ways to discuss the relationship between health and social factors – something that I think we all intuitively understand but struggle with connecting to practical strategies and initiatives. The RWJF report says it like this:

“Health is shaped by many factors, including education and family income and the resources and opportunities they provide, like access to nutritious food and adequate housing. In academic terms, we call these factors “social determinants of health.” In plain English, we say that the road to health starts long before illness, in our homes, schools and jobs.”

When it comes to FASD prevention, I think we can all agree that the road to preventing alcohol use in pregnancy starts long before a woman even thinks about getting pregnant. I thought this illustration from Poole’s 2003 report on preventing FASD by promoting women’s health was a good starting place for understanding some of the building blocks for creating this road.

“To be effective in FASD prevention efforts, we need to move from a focus on women’s alcohol use alone to increased understanding of related health and social problems experienced by women that contribute to FASD, and to provide a network of supports that directly address these contributing factors. Community health policy that addresses broader determinants of health is also foundational to successful FASD prevention.” (Poole, 2003, p. 5)

At one time or another, I think all of us involved with FASD prevention suffer from “it’s about the alcohol” myopia – especially when we’re confronted with a client or family member or friend who is using alcohol heavily – and are challenged to remind ourselves that “it’s about so much more than alcohol.”

If you catch me using the term “social determinants of health,” don’t be afraid to call me on it.


Poole, N. (2003). Mother and Child Reunion: Preventing Fetal Alcohol Spectrum Disorder by Promoting Women’s Health. Vancouver, BC: BCCEWH.


5 thoughts on “It’s not only about alcohol

  1. […] A story might be an excellent strategy for explaining how social factors like income, social support, and gender affect our individual health. (For more on the difficulties of communicating about these determinants, see a previous post A New Way to Talk about the Social Determinants of Health; for more on the social determinants in relation to FASD prevention, see It’s not only about alcohol). […]

  2. […] While alcohol use in pregnancy is a concern in women who are homeless, it is clear that focusing on changing individual alcohol and substance use is not the answer. A better understanding of the issues that women who are homeless face and the individual and social forces that have led them to being homeless in the first place are more likely to result in more sensitive, caring, and effective approaches to supporting women who are homeless. It’s a case where preventing FASD is about much more than the alcohol (see an earlier post on broadening our understanding of the causes of alcohol use during pregnancy here). […]

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