A conceptual framework for action on the social determinants of health

Abstract

Conceptual frameworks in a public health context shall in the best of worlds serve two equally important purposes: guide empirical work to enhance our understanding of determinants and mechanisms and guide policy-making to illuminate entry points for interventions and policies. Effects of social determinants on population health and on health inequalities are characterized by working through long causal chains of mediating factors. Many of these factors tend to cluster among individuals living in underprivileged conditions and to interact with each other. Epidemiology and biostatistics are therefore facing several new challenges of how to estimate these mechanisms. The Commission on Social Determinants of Health made it perfectly clear that policies for health equity involve very different sectors with very different core tasks and very different scientific traditions. Policies for education, labour market, traffic and agriculture are not primarily put in place for health purposes. Conceptual frameworks shall not only make it clear which types of actions are needed to enhance their “side effects” on health, but also do it in such a way that these sectors with different scientific traditions find it relevant and useful. This paper pursues an excellent and comprehensive discussion of conceptual frameworks for science and policy for health equity, and in so doing, takes the issue a long way further. Finn Diderichsen MD, PhD Professor, University of Copenhagen October, 2010