Social Determinants

A cross-disciplinary process to map the factors that shape health

In a series of sessions spread over one week of Joint Advanced Seminar 1 (JAS 1), Fellows focus on a particular health issue, (such as mortality in children under five). They begin with a literature search in discipline-specific groups and then present their findings to the other participants. Each discipline brings a new perspective on the causes of the issue. Fellows then work together to build a conceptual framework in order to group the social determinants of health and the links between them.

Procedure

The facilitator introduces the theme with this table, to illustrate the different levels at which determinants operate

  • In a classroom that allows participants to sit in some form of an agora and move around, five flipcharts are pegged to the wall or poster hangers for the five sections indicated in the table above
  • In groups, participants identify factors influencing a person’s health status, they note the factors on cards that are colour coded to indicate level
  • Groups present their cards back to the wider group as the basis for discussing all the factors influencing health at different levels. Together, they populate a board with different factors
  • Together, the whole group explores the interlinkages between factors. Individuals take turns, using string or tape, to represent the linkages on the board
  • Participants discuss how an understanding of the larger forces help us to design better and more appropriate interventions

References

  1. Cooper, Diana E. et al. The impact of development policies on health: A review of the literature, Geneva, World Health Organization, 1990. Ch.2 and Ch.7
  2. Dyches, Hayne and Rushing, Beth. International stratification and the health of women: An empirical comparison of alternative models of world-system position. Social Science and Medicine, 43:1996, pp 1063-1072.
  3. Arber S. Class, paid employment and family roles: making sense of structural disadvantage, gender and health status. Social Science and Medicine, 32: 1991, pp 425-436.