Systems change for the social determinants of health

摘要: Inequalities in the distribution of social determinants health are now a widely recognised problem, seen as requiring immediate and significant action (CSDH. Closing Gap Generation. Geneva: WHO; 2008; Marmot M. Fair Society, Healthy Lives: The Review. Strategic Review Health Inequalitites inEngland Post-2010. London; 2010). Despite recommendations for on dating back to 1980s, inequalities many countries continue grow. In this paper we provide an analysis from major reports using concept ‘system leverage points’. Increasingly, powerful effective is conceptualised that which targets government non-health issues drive outcomes. Recommendations 6 national were sourced. each report coded against two frameworks: Johnston et al’s recently developed Intervention Level Framework (ILF) Meadow’s seminal ‘12 places intervene system’ (Johnston LM, Matteson CL, Finegood DT. Systems Science Obesity Policy: A Novel forAnalyzing Rethinking Population-Level Planning. American journal public health. 2014;(0):e1-e9; Meadows D. Thinking Systems. USA: Sustainability Institute; 1999) (N = 166). Our found several changes over time types being made, including shift towards paradigmatic change away individual interventions. Results framework revealed number potentially system intervention points currently underutilised thinking regarding When viewed through systems lens, it evident power comes not where targeted, but rather how works create within system. This means efforts targeted at policy can have only limited effectiveness if they aimed changing relatively weak points. raises further (and more nuanced) questions about what looks like.