Research

The main determinants of health

The most widely used model to explain health inequalities is the Dahlgren-Whitehead ‘Rainbow model’. The model maps the relationship between the individual, their environment and health, also called the determinants of health. At the centre of the model is the individual who possesses individual, and often fixed, characteristic such as their age, sex and constitutional characteristics. The individual is surrounded by the various spheres that impact health and that are theoretically modifiable by policy. These include individual lifestyle factors, community influences, and living and working conditions.

The Rainbow model emphasises interactions: individual lifestyles are embedded in social norms and networks, and in living and working conditions. These in turn are related to the wider socioeconomic and cultural environment.

The determinants of health that can be influenced by individual, commercial or political decisions can be positive health factors, protective factors, as well as risk factors

Read more about the Rainbow model in our database.

The Marmot reviews

The ‘Marmot Reviews’ refer to the work that is carried out by Professor Sir Michael Marmot and his team at University College London (UCL). In 2008, Professor Sir Michael Marmot chaired an independent review of health inequalities in England. Besides assessing the situation, the review proposed the most effective evidence-based strategies for reducing health inequalities in England. All reports are available here.

#Marmot2020: The Marmot Review 10 Years On

In 2020, a new Marmot review, called The Marmot Review 10 years on, came out. The report assessed the state of health inequalities in England and the progress that was made over the last decade. The report found that health inequalities had increased and that the social gradient had become steeper over the previous decade. There were big differences in life expectancy between regions in England, and homelessness and child poverty had considerably increased.

European reviews

The WHO Regional Office for Europe commissioned a review of social determinants of health and the health divide. This review was executed by a group of experts led by Sir Michael Marmot. Its aim was to set out the health divide and inequalities in health in Europe. The review fed into the development of the WHO Europe’s Health 2020 strategy. A key goal of the review was to identify what works and how to implement good practices across the diverse context of the European Region.

The final report of the review was published in 2013. The review had identified key areas for action and the guidelines and good practices. The report set out new approaches towards reducing health gaps between and within European countries. These were complemented with guidelines for policies in each of the key areas for action. In addition, the report also urged countries to implement policies to mitigate the negative impact of social determinants of health. It showed that even small actions in these areas can improve health equity. It highlighted that, besides the moral argument for action, reducing health inequalities also makes economic sense.

The WHO Health Equity Monitor

Hosted on the WHO’s World Health Data Platform, the Health Equity Monitor provides evidence on existing health inequalities and makes available tools and resources for health inequality monitoring and research. It includes:

• The Health Equity Monitor Database, a large database of disaggregated data. It currently includes data for more than 30 reproductive, maternal, newborn and child health indicators, disaggregated by six dimensions of inequality, from over 450 international household health surveys conducted in 115 countries in 1991-2018.
• Interactive data visualizations, that present data from the Health Equity Monitor database in an interactive way.
• The Health Equity Assessment Toolkit (HEAT), a software application for assessing health inequalities in countries.
• Publications, including handbooks, manuals, advocacy booklets and reports.

The World Health Database Platform hosts a range of other key data tools, data sets and databases related to global health and wellbeing as well. Most notably, the Global Health Observatory data repository holds data on health-related statistics for the 194 WHO Member States. It provides access to over 1000 indicators on, among other topics, mortality and morbidity, the SDGs, health systems, environmental health and health equity.

Find all WHO data collections here.

Eurofound

Eurofound is the European Foundation for the Improvement of Living and Working Conditions. It aims to assist in the development of better social, employment and work-related policies in Europe.

Eurofound has three regularly repeated pan-European surveys that offer a unique source of comparative information on the quality of living and working conditions across the EU. These surveys are:

• The European Company Survey;
• The European Quality of Life Survey
• The European Working Conditions Survey

Some of the most relevant OECD data resources for health equity are:

• Health statistics, which offers comparable statistics on health and health systems across OECD countries. Every two years this data is used to write the Health at a Glance report.
• The OECD Gender Data Portal, with indicators on education, employment, health and many more.
• Education statistics, which offers statistics on education systems, economic and social outcomes of education and training, but also the human and financial resources invested in education systems. Findings on education are summarised in the biannual Education at a Glance report.
• Employment and labour statistics, where data is broken down by sex and age, and users find statistics about part-time work, unemployment duration, and minimum wages.
• Social and welfare statistics, with indicators on social expenditure and benefits.