The Broader Determinants Of Health

The broader determinants of health (see figure 1 – Dahlgren and Whitehead - original model) reflect the environment in which people live and how it influences their health.

These determinants of health, and their effects on inequalities in health, were comprehensively outlined by the Independent Inquiry into Inequalities in Health chaired by Sir Donald Acheson (1998).  

The main conclusions of the Inquiry were:

• The weight of scientific evidence supports a socio-economic explanation of health inequalities. This traces the roots of ill health to determinants such as income, education and employment as well as lifestyles and the physical and material environment.
• Action to tackle health inequalities therefore reaches far beyond the remit of Government Health Departments or the NHS.  Some relate to the whole of government while others relate to particular departments, such as education.

The key ‘non-health’ areas for future policy development were identified as:

• Financial - poverty, employment, income, tax and benefits.
• Environmental – housing, mobility, transport and pollution.
• Nutrition and the common agricultural policy.
• Education.

It was felt that a high priority should be given to the health of families with children and that further steps should be taken to reduce income inequalities and improve the living standards of poor households.

Figure 1: Dahlgren and Whitehead (1991) famously pictorially illustrated the broader determinants of health as:

The diagram succinctly illustrates the range of different influences on health but also how complex the picture really is.  In particular:

• How varied the types of influence are – particularly social and environmental influences.
• How complex the picture of health is – most factors interact with each other, and in complex ways, to produce health outcomes.
• Some factors have greater influence on an individual’s health than others, but the balance of influences can change with time.

 

Action to improve health and reduce health inequalities therefore needs to be co-ordinated at a population level to ensure that the overall outcome is health gain - especially for priority or vulnerable groups.  This may be very difficult to achieve in practice, for example, when police, education and health services have different approaches to drug misuse by young people, but may be assisted by conducting a health needs assessment to gain an overview of the likely broad impact of a certain policy or group of policies.

Further information on the broader determinants of health and priorities for tackling inequalities is available from each of the UK government health departments.