Bridging the Gap: A health inequalities learning resource

Introducing the Wider Determinants of Health

Health Inequalities

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.

Wider Determinants of Health image

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.

Individual lifestyle 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 activity.

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 matters.

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 fuel.

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, clothing

These general conditions can directly affect government spending capacity, and in turn have a direct influence on health and social policy priorities.


Case study two - Alex

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 on:

  • social attitudes
  • social cohesion
  • social mobility

Pause for thought…

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:

  • Living and working conditions?
  • Social and community networks?   
  • Lifestyle factors?
  • Health and wellbeing?


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