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Overview and framework 

Overview and framework
Chapter:
Overview and framework
Author(s):

Orielle Solar

, Alec Irwin

, and Jeanette Vega

DOI:
10.1093/med/9780199218707.003.0006
Page of

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date: 19 June 2019

This chapter presents a conceptual framework within which to understand the multiple determinants that shape patterns of disease and well-being in populations. This provides a basis for evaluating where and how public health can intervene most effectively to improve health, particularly for vulnerable groups. This chapter starts from the premise that the central challenges for public health today include not just improving average health indicators, but reducing the unfair differences in health that currently exist among social groups, between and within countries. In other words, public health practice must be concerned with strengthening health equity. Getting to grips with this challenge requires finding answers to three fundamental problems:

1. Where do health differences among social groups originate, if we trace them back to their deepest roots?

2. What pathways lead from root causes to the stark differences in health status observed at the population level?

3. In light of the answers to the first two questions, where and how should we intervene to reduce health inequities?

This chapter seeks to provide a framework that can establish responses to the first two of these questions, in particular. Later chapters will investigate specific health determinant topics in greater detail. Our discussion here paints in the ‘big picture’ within which the more detailed analyses reveal their full meaning.

We begin by defining key concepts. We then review influential paradigms for understanding health determinants. Subsequent sections present a conceptual framework for analysis and action on the determinants of health, paying special attention to the determinants of health inequities. A final section sketches implications of this model for public health policy and practice. This chapter reflects work undertaken from 2004 to 2007 within the former Department of Equity, Poverty and Social Determinants of Health1, World Health Organization, in connection with the WHO-sponsored Commission on the Social Determinants of Health (Solar & Irwin 2007).

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