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A conceptual framework for action on the social determinants of health

This paper, the second in a series produced by the World Health Organization’s (WHO) Commission on the Social Determinants of Health (CSDH), outlines a conceptual framework for action on the social determinants of health.

The framework, which guided the CSDH’s work from 2005 to 2008, was built on theoretical models to explain the underlying processes of “causation” that underpin health inequities. As an “action oriented” framework, it is designed to help policy-makers pinpoint where to intervene in these underlying processes to most effectively fight health inequities. The model includes three core components: 1) socioeconomic and political context; 2) structural determinants of health inequities; and 3) intermediary determinants of health.

The authors make a critical distinction between the structural determinants of health inequities and the intermediary determinants of health. The structural determinants include “all social and political mechanisms that generate … stratification and social class divisions in society and that define individual socioeconomic position within hierarchies of power, prestige and access to resources” (p. 5). The structural determinants cause and operate through intermediary determinants of health—housing, physical work environment, social support, stress, nutrition and physical activity—to shape health outcomes.

The authors draw heavily from work by Diderichsen et al. (2001),  as well as from theories of power, to make the case that effective actions on the social determinants of health are inherently political, in that they seek to change large-scale structural power relations between more and less privileged groups.

Use this resource to

  • Distinguish between the mechanisms underlying social stratification and the intermediary determinants of health that are caused by stratification and that lead to inequities in health
  • Identify where policy interventions can address both downstream and upstream causes of health inequities
  • Ground policy action on the social determinants of health in an evidence-informed, theoretical framework


Solar O, Irwin A. (2010). A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva; World Health Organization.

Tags: Critical works in health equity, Healthy public policy, Key concepts, Leadership & capacity building, Document

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