Social Determinants of Health Conceptual framework

CSDH Doc 2 - Conceptual framework.pdf (application/pdf Object)
The Commission on Social Determinants of Health (CSDH) has affirmed its desire to be judged not only on the scientific rigor of its analyses, but on the policy and institutional changes catalysed in countries through Commission advocacy and partnership. To set feasible objectives for its political work and send consistent messages to partners and the public, the CSDH requires clarity on basic conceptual issues. These include:
• The concept of social determinants of health (SDH)
• The values that ground the Commission's analysis and policy recommendations
• The pathways by which SDH affect health status and outcomes
• How SDH relate to health inequities
• The most important SDH for the Commission to address, and why
• Appropriate intervention levels and entry points for policy action on SDH
• The ultimate goal of SDH policies (improving average health status or reducing health inequities)
This paper outlines a conceptual framework we hope can serve as a basis for discussion and clarification of these issues within the CSDH. The paper in its current form is an early draft, which aims to open debate rather than furnish definitive answers. It summarizes the results of an initial phase of research and analysis by the CSDH secretariat. The paper will pass through subsequent iterations to incorporate input from Commissioners and yield a final document succinctly laying out the conceptual foundations of the Commission's work.
The paper begins by recalling the CSDH definition of social determinants and some methodological implications. It then takes up the question of values. We propose the concept of health equity as a cornerstone for the Commission's normative framework. Applying equity criteria, we consider the implications of policy approaches focused respectively on: (1) tackling health disadvantages in targeted population groups; (2) reducing health gaps; and (3) addressing the health gradient across the full spectrum of socioeconomic positions. The next section of the paper reviews several models that have sought to explain relationships among SDH and their causal role in generating health inequities. Drawing lessons from these approaches, we propose a comprehensive SDH framework that situates the major determinants and clarifies levels for policy action. Using this model, we then show how and why a set of key thematic foci for the Commission's work have been proposed. Finally, we review several evaluative frameworks the CSDH could use in developing policy recommendations and suggest some principles to ground those policy choices.