3.1 Conceptual Frameworks for Social Determinants of Health

Social determinants of health shape our well-being from birth to death. The WHO's framework shows how societal structures and personal circumstances intertwine to create health outcomes and inequities.

Ecological and life course models reveal how our surroundings and experiences accumulate over time to influence health. These frameworks help us understand the complex web of factors that determine who stays healthy and who gets sick.

Conceptual Models

WHO Commission on Social Determinants of Health (CSDH) Framework

• Developed by the World Health Organization to understand and address social determinants of health
• Emphasizes the importance of socioeconomic and political context in shaping health outcomes
• Recognizes the role of structural determinants (social, economic, and political mechanisms) in generating health inequities
• Highlights the impact of intermediary determinants (material circumstances, psychosocial factors, behavioral and biological factors, and health system) on health

Ecological and Life Course Models

• Dahlgren-Whitehead rainbow model depicts layers of influence on health, from individual lifestyle factors to general socioeconomic, cultural, and environmental conditions
• Ecological model emphasizes the interaction between individuals and their environment (physical, social, and cultural) in shaping health behaviors and outcomes
• Recognizes multiple levels of influence on health: intrapersonal, interpersonal, organizational, community, and public policy
• Life course perspective considers the cumulative impact of social, economic, and environmental exposures across an individual's lifetime on health outcomes
• Emphasizes critical periods (early childhood, adolescence) and transitions (leaving school, retirement) that can influence health trajectories

Key Concepts

Social Determinants of Health and Health Equity

• Social determinants of health refer to the conditions in which people are born, grow, live, work, and age that shape health outcomes
• Include factors such as income, education, housing, employment, social support, and access to healthcare
• Health equity is the absence of avoidable, unfair, or remediable differences in health among population groups
• Achieving health equity requires addressing the root causes of health disparities and ensuring equal opportunities for health

Intersectionality and Its Impact on Health

• Intersectionality recognizes that individuals have multiple, intersecting social identities (race, gender, class, sexuality, disability) that shape their experiences and health outcomes
• Intersectional approach examines how these identities interact with systems of power and oppression to create unique challenges and opportunities for health
• Helps to understand the complex, cumulative impact of social determinants on health for different population groups (women of color, LGBTQ+ individuals with disabilities)
• Informs the development of targeted interventions and policies to address health inequities

Determinants Classification

Upstream and Downstream Factors

• Upstream factors refer to the fundamental social, economic, and political structures that shape the distribution of resources and opportunities for health
• Include policies, institutions, and systems that influence living and working conditions, access to education and healthcare, and social and economic inequalities
• Downstream factors are the proximal, individual-level determinants of health that are influenced by upstream factors
• Include health behaviors (diet, physical activity, smoking), psychosocial factors (stress, social support), and access to and quality of healthcare services
• Addressing upstream factors through policy and structural interventions can have a broader, more sustainable impact on population health compared to downstream, individual-level interventions (health education campaigns, behavior change programs)