Dahlgren and Whitehead’s model for the social determinants of health
First devised in 1991, the Dahlgren and Whitehead model of the social determinants of health (Figure 2) has become widely used and maps out the social, economic, environmental and lifestyle factors that can influence the health of a person. Individual factors are at the centre of the diagram while wider social, economic and other factors are represented on the outside.
This model is considered useful (and is promoted by a range of national and international governments and organisations) as it helps us think beyond the idea that our health outcomes are just governed by personal decisions. As an educator you may notice how certain factors represented in the diagram might affect your learners’ ability to fully engage with their studies and have an effect on their performance and attainment.
Activity 3 Exploring the impact of social determinants of health
Part 1
- Choose two of the course case studies from the following document: Case studies [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] (open the link in a new tab or window so you can easily find your way back to the course).
- Read each one in turn and use the Dahlgren and Whitehead model to note which determinants you think could be influencing their mental health.
- You might want to start with the individual factors first, working out to wider social factors relevant to each person.
- Take a moment to consider how this model might apply to you yourself.
Discussion
As we are all individuals with our own experiences, social connections and different circumstances, this model helps us appreciate how people in seemingly similar situations can experience quite different mental health outcomes. For example, siblings, or even twins, growing up in the same household can experience different health outcomes despite growing up in the same environment. Sometimes our circumstances may make us more, or less, likely to experience poor mental health if some individual and social factors result in us experiencing adversity or trauma. You may hear this called ‘intersectionality’ (Crenshaw, 2017), which refers to how a combination of factors can interact and further increase the likelihood of changes in mental health. This could be where someone experiences adversity because of intersectionality of, for example, their ethnicity, religion, sexuality and/or disability status.
Part 2
- Revisit the case studies you chose for Part 1.
- Can you identify any factors about each person which could represent ‘intersectionality’?
Discussion
Combined factors of gender, sexuality, ethnicity, disability, environment, education, access to healthcare and/or socioeconomic status may all compound an individual’s disadvantage or inequity and can profoundly affect their mental and/or physical health.