Individual & Collective Determinants of Mental Health

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Scoping Review of Social Determinants of Health…

Communicating the SDOH through conceptual models.

The model, or conceptual framework, approach moves beyond a list of SDOH to show (often visually) how various elements interconnect and are experienced at different levels (e.g., societal, community, family, individual) to produce different outcomes (e.g., opportunities, health outcomes, distribution of opportunities). Most models share the idea that health represents a web of social influences.[103] Well-known examples of SDOH models, presented in chronological order, include Evans and Stoddart’s (1990) framework, which shows how individual and social factors interact outside of the health care system,[22] Whitehead and Dahlgren’s (1991) ‘rainbow model’ which shows concentric half-circles of influential social factors,[104] and more recently, Solar and Irwin’s (2007) conceptual model produced for the WHO that shows the multiple directions through which structural and intermediary determinants impact health and health equity.[16] Lesser known examples include Fox and Meier’s (2009) right to development SDOH model [21] and the model for Métis SDOH that shows interrelationships specific to this population (e.g., self-determination, land, colonization).[66] While numerous other models exist, they have been documented elsewhere [e.g., [20, 89, 93, 103, 105–106]] and will not be reviewed here. A comprehensive and illustrative guide to various models of the SDOH, including those outside the scope of this review, is provided in MacDowell’s webpage created for medical students at the University of Ottawa in Canada.[107]

The model approach also brings potential challenges and benefits to communicating the SDOH. They are particularly beneficial in that they depict the influence of social, economic, and political factors at multiple levels. Some models even identify areas where action on the SDOH can be taken.[15, 108] Others serve to illustrate pathways, which are helpful to individuals in understanding the ‘how’ behind the SDOH. One of the challenges is that they may oversimplify (and thus misrepresent) or overcomplicate (and thus overwhelm) the SDOH. To the extent that models and lists do not resonate with members of the public, for any reason, they may not instill a sense of need or urgency to act (e.g., contact their elected representative on SDOH-related matters), to the detriment of public engagement in public policy decision-making.

The Social Origins of Illness: A Neglected History, Howard Waitzkin (1981)