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Social Determinants of Health

Learn more about the social determinants of health.

In this step, we will explore a model of the social determinants of health, review how this model of the social determinants of health can impact on your practice, and look at the points at which you, as a nurse, can intervene to improve health.

As healthcare practitioners, it is important that we recognise that health is a much bigger issue than only ensuring a population has access to good quality healthcare services. As Nightingale understood, health is a social, political, environmental, and economic issue.

Watch this video, in which Pauline starts by explaining the concept of downstream, midstream, and upstream healthcare and the importance of moving health upstream. She then goes on to look at the Dahlgren and Whitehead model which displays the multifactorial nature of health – aspects that are not readily amenable to change and lifestyle factors that are modifiable. This model is also known as the policy rainbow.

You can access a copy of the Dahlgren and Whitehead policy rainbow from the Downloads section at the bottom of the page.

Your Task

In the discussion, share your area of nursing practice (e.g. diabetes, intensive care, children and young people) and identify how you can intervene upstream on up to four elements of the Dahlgren and Whitehead model.


Dahlgren, G., and Whitehead, M. (1991) Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Future Studies Stockholm

Dahlgren, G., and Whitehead, M. (2007) European Strategies for Tackling Social Inequities in Health: Levelling up Part 2. [online] Copenhagen: WHO. available from [18 June 2018]

WHO (2008) Closing the Gap in a Generation. Geneva: WHO

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Public Health and Nursing: Drive Public Health Promotion

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