1 Exploring the factors that influence health
Using the framework provided by Dahlgren and Whitehead (1991), this chapter now moves on to explore the factors that influence health.
Thinking point: to what extent do you think that the factors identified by Dahlgren and Whitehead in Figure 1 influence your own health?
This multifactoral approach differentiates between individual and social factors, offering a diagram with layers which can be peeled away. The core of the diagram consists of inherited attributes relating to age, sex and hereditary factors. The inner layer suggests that health is partly determined by individual lifestyle factors, such as patterns of smoking, physical activity and diet. Moving outwards, the diagram draws attention to relationships with family, friends and significant others within the local community. These are the downstream determinants of health – the actions of individuals and communities. The next layer focuses on working and living conditions – housing, employment, access to healthcare services and so on. The outer layer highlights broader socio-economic, cultural and environmental forces such as economic development, shifts in welfare systems, political change, social forces and structures. These final two layers relate to the upstream determinants of health. Although it is not really shown in the diagram, there is potential for layer-to-layer interaction. For example, cutbacks in welfare services might adversely affect people’s access to adequate housing and thus influence their health.
Activity 1 Investigating living and working conditions
Look back at the Dahlgren and Whitehead diagram (Figure 1). Select one influencing factor from the ‘living and working conditions’ layer of the diagram and make some notes on why you consider that factor is important in shaping health.
Transport could be identified as a health issue but one that is ‘hidden’. It is seen as a private matter so that when people can’t make hospital appointments, job interviews or college classes the responsibility and blame attaches to the individual concerned, not to the inadequacy of transport services. If people have to shop in expensive local shops or forgo social occasions and outings these, too, are privately experienced. Yet the social isolation, poverty and poorer diet that might result from lack of access to transport can adversely influence people’s mental and physical health.
Health inequalities are complex, with genetic, cultural and socio-economic factors interacting to influence health. One of the key indicators for health inequalities is poverty. You can access more evidence about European-wide health inequalities via the, a collaborative website development which also has a directory of good practices to reduce health inequalities.