CDE Appendix 1 Literature Review - Central East Local Health ...

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The Culture, Diversity and Equity Project: Literature Review Figure 2.9: WHO Commission on Social Determinants of Health conceptual framework Source: WHO, 2008, p.43. Amended from Solar & Irwin, 2007. While the WHO Report does not elaborate further upon its underlying conceptual framework modeled above (referring readers instead to the original source), the model clearly brings a wide range of health determinants into scope. Like the New Zealand model, it too stresses the more determining role of structural socio-political and economic factors and contexts in shaping health inequities. The Commission for instance argues in this respect: Strengthening health equity globally and within countries means going beyond contemporary concentration on the immediate causes of disease. More than any other global health endeavour, the Commission focuses on the ‘causes of the causes’ the fundamental global and national structures of social hierarchy and the socially determined conditions these create in which people grow, live, work, and age (WHO, 2008). The framework, moreover, implicitly adopts a “life-course perspective on how the social determinants of health operate at every level of development - pregnancy and childbirth, early childhood, childhood, adolescence, and adulthood - both as an immediate influence on health and to provide the basis for health or illness later in life” (WHO, 2008:49). The Commission uses this framework to discern two fundamental kinds of interventions that are aimed at taking action on: The circumstances of daily life, including: • Differential exposures to disease-causing influences in early life, the social and physical environments, and work, associated with social stratification. Depending on the nature of these influences, different groups will have different experiences of material conditions, psychosocial support, and behavioural options, which make them more or less vulnerable to poor health; • Health-care responses to health promotion, disease prevention, and treatment of illness; 28
The Culture, Diversity and Equity Project: Literature Review And the structural drivers, including: • The nature and degree of social stratification in society – the magnitude of inequity along the dimensions listed; • Biases, norms, and values within society; • Global and national economic and social policy; • Processes of governance at the global, national, and local level (p.42). Three overarching ‘principles of action’ are derived from the Commission’s analysis of the determinants of health. These structure the report’s chapters and provide the overarching framework for the large number of recommendations contained in this report. These three ‘principles of action’ include: 1. Improve the conditions of daily life - the circumstances in which people are born, grow, live, work, and age. 2. Tackle the inequitable distribution of power, money, and resources - the structural drivers of those conditions of daily life - globally, nationally, and locally; and 3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health. The Commission emphasizes and draws attention to the solid evidence-base informing these principles of action, which it explains are: • Underpinned by an aetiological conceptual framework, • Supported by a vast global evidence base that demonstrates an impact of action on these social determinants of health and health inequities (effectiveness), • Supported by evidence on feasibility of implementation in different scenarios, and • Supported by evidence showing consistency of effects of action in different population groups and countries with different levels of national economic development (p.43). A second public health conceptual framework/model identifying the causal pathways of health in/equity is elaborated in the body of the (2008) WHO Report (see Figure 2.10). 29
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