Explaining social determinants and health risk: The case of female sex workers in Hong Kong and China

The modern study of the social determinants of health were said to have begun with Rudolph Virchow and Friedrich Engels whom not only made the explicit link between living conditions and health but also explored the political and economic structures that create inequalities in the living conditions which lead to health inequalities. (Rather 1985; Engels 1987). Recently, international interest in the social determinants of health has led to the World Health Organization's creating a Commission on the Social Determinants of Health. (WHO 2008) In its final report Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health the commission succinctly summarises the current state of knowledge: "Social justice is a matter of life and death.These inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces. Sex work provides, perhaps, the most vivid example of which the forces of social and economic inequality and marginalisation, could create power imbalances which contribute to social and health disintegration. This is particularly magnified for migrant female sex workers in rapidly developing countries (Wilkinson, 1996). Limitations of the research to date is the insufficiency of careful empirical address of the complexity of gender, socio economic equity and migrant health and the skewed view of such under the influences of HIV agenda in the last two decades. Furthermore there is a documented absence of data on migration and sexual health studies that explores issues of vulnerability. This, in turn, has contributed further to the lack of comprehensive responses directed at lower socio-economic migrant women.