Policies and strategies to promote social equity in health

Policies and strategies to promote social equity in health was a background document to the WHO Strategy for Europe, published in 1991. The document set out to further develop the discussion on improving health equity by outlining a strategic approach.

The document is most-known for first introducing the Dalhgren and Whitehead’s Rainbow Model that conceptualises the determinants of health. The model maps the relationship between the individual, their environment and 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 determinants of health, such as smoking, education levels, and poverty are located within these spheres.

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

Find the WHO background document Policies and strategies to promote social equity in health here. 

The model is further elaborated on in a report called European strategies
for tackling social inequities in health – part 2, by WHO Europe. Find that report here.