Dahlgren and Whitehead's 1992 representation of the
wider determinants of health below informed the
Acheson Report (DH, 1998) and the Scottish
Government's Equally Well (SG, 2008a). It still stands as the most
effective illustration of health determinants and continues to
inform the work to of those concerned with understanding and
reducing the health inequality gap.
Age, sex and hereditary
factors: in Dahlgren and Whitehead's model personal
characteristics (such as age, sex, ethnicity and constitutional
factors (e.g. genetic, biological) occupy the core.
These factors are highly significant for health, yet they
are largely seen as beyond the reach and influence of public health
improvement strategies, policies and practices. However, other
factors, that can in turn be influenced, extend out in layers from
the model's core.
factors: sometimes described as lifestyle
'choices', this layer refers to behaviours such as smoking, alcohol
and other drug misuse, poor diet or lack of physical
Social and community
networks: networks refers to family (parents,
children, partners), friends and the wider social circles around
us. Social and community networks are a protective factor in terms
of health. And although it may risk stating the obvious, it is the
quality rather than quantity of relationships that
Living and working
conditions: includes access to and opportunities in
relation to, for example; education, training and employment,
health, welfare services, housing, public transport and amenities.
It includes facilities like running water and sanitation, and
having access to essential goods like food, clothing and
General socio-economic, cultural and
environmental conditions: represents social,
cultural, economic and environmental factors that impact on health
and wellbeing and include, for example, wages, disposable income,
availability of work, taxation, and prices; fuel, transport, food,
These general conditions can directly affect government
spending capacity, and in turn have a direct influence on health
and social policy priorities.
See questions 1-3
Dahlgren and Whitehead's model highlights a causal relationship
between individual lifestyle 'choices', social networks, working
and living conditions and economic, political and environmental
factors, globally, nationally and locally.
While the configuration of these different layers
and factors can have both positive and protective influences on our
lives, they can also undermine health and wellbeing, both for
individuals and communities.
For example, adverse economic conditions have implications
for employment and training opportunities, public services such as
health, social care, education, the wide range of services provided
by local authorities, as well as the funding they provide to
support local voluntary sector services. Where adverse conditions
persist, they can have a significant and negative impact
In recent years discussion about the economic conditions has
been dominated with the language of 'recession' or 'downturn' or
'crisis', or 'credit crunch' or 'cuts'...
What kind of impact do you think the economic conditions
are having on:
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