This report from the Canadian Council on Social Determinants of Health (CCSDH) illustrates the many ways in which the determinants of health - factors such as housing, income, education, employment, and social support networks - can be depicted in a framework and the range of possible uses for such frameworks. These uses include raising awareness of the determinants of health, improving our understanding of complex problems, and supporting planning and policy development to advance action on the determinants. The frameworks included in the review vary in design from the simple, such as those designed to communicate the determinants of health to a broad audience, to the complex, such as those designed to take action on the root causes of health inequities. CCSDH holds that the study and use of these frameworks can help shift public health practice towards more intersectoral, development-oriented, upstream approaches.
This report provides a brief analysis of 37 frameworks on the determinants of health and an in-depth analysis of 7 frameworks deemed most useful for understanding and acting on the social determinants across sectors. They are categorised as 1) explanatory, used to explain the concept of health determinants to uninitiated audiences; 2) interactive, identifying points of interaction and the relationships between them; or 3) action-oriented, focusing on the decision or policy-making process. The frameworks were further grouped according to their primary area of focus, as follows: 1) Policy Development and Decision-Making; 2) Practice Approach (Population Health, Health Reporting, and Community Development); 3) Issue Focus (Ecosystems and Environment, Living and Working Conditions); 4) Population Focus (Gender, Aboriginal Peoples, Children, Rural); and 5) Broad Focus.
Following the categorisation (by type) and grouping (by primary focus) used to develop the Compendium (pages 4-8 of the report), a selection of frameworks were identified from among the 36 for an in-depth review, including: 1) First Nations Holistic Policy and Planning Model (Assembly of First Nations (AFN), 2013); 2) A Conceptual Framework for the Planning of a Healthy Community (Gudes et al., 2010); 3) Toward Health Equity: A Framework for Action (Daghofer & Edwards, 2009); 4) The WHO [World Health Organization] Commission on the Social Determinants of Health's Conceptual Framework and Framework for Action on Tackling Social Determinants of Health Inequities (WHO, 2007); 5) A Framework for Addressing the Social Determinants of Health and Well Being (Queensland Health, 2001); 6)Wider Determinants of Health Model (Dahlgren & Whitehead, 1991); and 7) Mandala of Health (Hancock & Perkins, 1985). Each framework is pictured (visually) and described in Section 3 of the report.
During the description and assessment of the 7 frameworks, several key elements were identified as relevant to advancing action on the determinants of health, namely: Elements 1 and 2 - use of a holistic and intersectoral approach; Element 3 - recognition of social exclusion; Element 4 - role of individuals and communities; Element 5 - importance of upstream action; Element 6 - clear identification of interactions between determinants. These elements are identified in the highlights section of the report (3.3) and further explored in Section 3.4 Discussion of Key Elements. The frameworks were analysed to determine how well they: reflect an intersectoral perspective; identify points of entry for different sectors; demonstrate how different sectors can take action to maximise impact; and include ecological factors, the Canadian context, and Aboriginal health.
CCSDH is a collaborative, multisectoral stakeholder group that works to influence the factors that shape health and wellbeing. It brings together individuals and organisations from many sectors in Canada, such as urban planning, social policy, public health, municipalities, Indigenous organisations, philanthropy, and research.
National Collaborating Centre for Determinants of Health (NCCDH) website and CCSDH website, both accessed on March 8 2017. Image credit: CCSDH