Pure Mathematics (FNDM PM2.1) – Spring - 20 – makeup (Assign.docx

Pure Mathematics (FNDM PM2.1) – Spring - 20 – makeup
(Assignment) –ALL – QP
MEC_AMO_TEM_034_01 Page 1 of 9
Instructions to Student
• Answer all questions.
• Deadline of submission: 10th /May /2020 23:59
• The marks received on the assignment will be scaled down to
the actual weightage
of the assignment which is 40 marks
• Formative feedback on the complete assignment draft will be
provided if the draft is
submitted at least 10 days before the final submission date.
• Feedback after final evaluation will be provided within two
weeks as per MEC
polices.
Module Learning Outcomes
The following LOs are achieved by the student by completing

the assignment successfully
1. Solve quadratic equation and graph Quadratic Function
2. Sketch exponential and logarithmic functions and solve
exponential and logarithmic equations
3. Apply trigonometric functions and formulae
4. Calculate probability and basic statistical measurents
Assignment Objective
This assignment is to be undertaken as individual work. You
will test your understanding on learning
outcomes of the topics on Solving quadratic equation and graph
Quadratic Function, solving exponential
and logarithm equations, on unit circle & trigonometric
functions and on statistics and probability
measurements. Students should be able to collect data and
analyze them.
`
IN SEMESTER (INDIVIDUAL) ASSIGNMENT
Module Code: FNDM PM2.1
Module Name: Pure Mathematics

Level: 0 Max. Marks: 100
Assignment Tasks
1. A gardener has 140 feet of fencing in a rectangular vegetable
garden.
a. Find a function that models the area of the garden he can
fence. ( 12 marks)
b. Find the dimensions of the largest area he can fence?
( 8 marks)
2. A certain breed of rabbit was introduced onto a small island
about 8 years ago. The current
rabbit population on the island estimated to be 4100, with
relative growth rate of 0.55 per
year.
a. What is the initial size of the rabbit population?
( 6 marks)

b. Estimate the population 12 years from now?
( 7 marks)
Where:
A population that experiences exponential growth increases
according to the model
�(�) = �0�
��
�(�) = ��
�0 = �� ℎ� ��
� = �� ℎ
� = ��
3.
a. The ship at sea is 120 miles from one radio station and 150
miles away from another. The
distance between the two stations is 200 miles. Approximate the
angle between the two
signals? (The

Solution
should contain a diagram/ drawing of the problem) (15
marks)
b. Prove that:
(10 marks)
sin(� + �) − sin (� − �)
cos(� + �) + cos (� − �)
= ��

4. Use steps app to walk for 7 days not less than 2000 steps
(Remark: download the application
from mobile store and take screenshot for the 7 days
measurements). Then use the data to
calculate measures of central tendency.
( 20 marks)
5.
a. Find the domain for the following:
(5 marks)
�(�) =
2�2 + 5� + 3
2�2 − 5� − 3

b. Find � −1(�) ��: �(�) =
3
2−4�5
(10 marks)
c. The table describes the distribution of a random sample S of
100 individuals, organized
by gender and whether they are right- or left-handed. Let’s
denote the events M = the
subject is male, F = the subject is female, R = the subject is
right-handed, L = the
subject is left-handed. Compute the following probabilities:
(7 marks)

i. P(M)
ii. P(R)
iii. P(M AND R)
iv. P(F or L)
Right-handed Left-
handed
Males 43 9
Females 44 4

Rules & Regulations:
• Explain with suitable diagrams wherever required. Diagrams
must be drawn using suitable
software or by pencil.
• Each student has to do the assignment individually
• The assignment answers should be in your own words.
Guidelines:

1) Submit this assignment on or before 10 /05/2020 (23:59)
which must include:
• All solution steps.
• The solution must be submitted in a word file through the link
available in Moodle.
• For the sketches if need you should insert them in same word
file with solution and you can also
use word file tool to draw or Excel.
• The final assignment must have a Title page and page
numbers.
• Title Page must have Assignment Name, Module name,
Session, your name, ID, and the name of
the faculty.
• Softcopy in word format is to be submitted through Turnitin
link on Moodle.

• Assignment must be computer typed.
➢ Font - Times New Roman
➢ Font – Style - Regular
➢ Font - Size - 12
➢ Heading should be with Font Size 14, Bold, Capital and
Underline.
• Explain with suitable diagrams wherever required. Diagrams
must be drawn using suitable
software or by pencil.
• Each student has to do the assignment individually.
• You can refer books in eLibrary or use internet resource. But
you should not cut and paste material
from internet nor provide photocopied material from books. The
assignment answers should be

in your own words after understanding the matter from the
above resources.
Important Policies to be followed
1. Student Academic Integrity Policy*:
MEC upholds the spirit of academic integrity in all forms of
academic work and any form of violation
of academic integrity shall invite severe penalty. Any benefit
obtained by indulging in the act of
violation of academic integrity shall be cancelled.

All cases of violation of academic integrity on the part of the
student shall fall under any of the below
mentioned categories:
1. Plagiarism
2. Malpractice
3. Ghost Writing
4. Collusion
5. Other cases
If the student fails a module and has a proven case of academic
integrity violation in this module, the
student is required to re-register the module. This is applicable
to first and second offenders of
plagiarism.
1. Plagiarism

A. First offence of plagiarism
I. If a student is caught first time in an act of plagiarism during
his/her course of study in
any assignment other than project work, the student will be
allowed to re-submit the
assignment once, within a maximum period of one week.
However, a penalty of
deduction of 25% of the marks obtained for the resubmitted
work will be imposed.
II. Period of re-submission: The student will have to re-submit
the work one week from the
date he or she is advised to re-submit.
III. If the re-submitted work is also found to be plagiarized,
then that assessment will be
awarded a zero mark. Re-submission of the work beyond the
maximum period of one

week will not be accepted and the assessment will be awarded a
zero mark.
B. Second offence of plagiarism
If any student is caught second time in an act of plagiarism
during his/her course of study (in a
subsequent semester), the student will directly be awarded zero
for the work in which plagiarism
is detected. In such cases, the student will not be allowed to
resubmit the work. A warning of
suspension shall be issued, and student has to sign an
undertaking and undergo counselling
session in such cases.
2. Malpractice/Ghostwriting/Collusion
A. First offence of Malpractice/Ghostwriting/Collusion

If a student is caught in an act of
Malpractice/Ghostwriting/Collusion for an assessment
component irrespective of coursework or end semester, the
student shall fail the module
and shall be required to re-register the module
B. Second Offence of Malpractice/Ghostwriting/Collusion
If a student is caught a second time in an act of
Malpractice/Ghostwriting/Collusion for
an assessment component irrespective of coursework or end
semester, the student
shall fail the module. A warning of suspension shall be issued,
and student has to sign

an undertaking and undergo counselling session in such cases.
3. Third Offence of Academic Integrity Violation
If a student is caught a third time in an act of Academic
Integrity Violation for an assessment
component irrespective of coursework or end semester (in a
subsequent semester), the student
shall fail the module and also shall be suspended for one
semester from the College, as
recommended by institutional level academic committee,
Chaired by the Associate Dean, Academic
Affairs.
4. Fourth Offence of Academic Integrity Violation:
If a student is caught a fourth time in an act of Academic
Integrity Violation for an assessment
component irrespective of coursework or end semester (in a

subsequent semester), the student shall
fail the module and also shall be expelled from the College, as
recommended by institutional level
academic committee, Chaired by the Associate Dean, Academic
Affairs.
5. Other cases
If a student commits an act of academic integrity violation as
per the definition of “other cases”
mentioned in the previous section or of a different nature,
student’s case shall be forwarded to an
institutional level academic committee, Chaired by the
Associate Dean, Academic Affairs. The
committee shall investigate the case by means of a viva and/or a
disciplinary hearing and shall take
appropriate decision. The penalty that can be granted to a
proven case of academic integrity violation

which falls in this category of “other cases” can be a
warning/component zero/ module
fail/suspension/expulsion depending on the nature and gravity
of the offence.
6. Types/Variations of Cases:
I. If plagiarism is detected in any component of one assessment,
the deduction in marks will be
applicable for the whole assessment, even if only the component
or part submission alone needs
to be resubmitted.
II. If plagiarism is detected in a group assessment, all students
of the group will be considered as
having committed an act of plagiarism and the policy will then
be applied to all students
III. If plagiarism is detected in any component of a group

assessment, the deduction in marks will be
applicable for the whole assessment even if only the component
or part submission alone needs
to be resubmitted.
All students of the group would be considered as having
committed an act of plagiarism and the
policy will then be applied to all the students of the group.
IV. If the assessment consists of components or part
submissions that could be a group assessment
component (e.g. group assignment) and an individual
assessment component (e.g. individual

reflection), the following will be applicable:
a. If plagiarism is detected in the group assessment component,
all students of the group
will be considered as having committed an act of plagiarism,
The policy will then be
applied to all students of the group. Group assessment
component will be resubmitted
as per the policy.
b. If plagiarism is detected in the individual assessment
component, the individual
assessment component will be resubmitted and the policy will
then be applied to that
student alone.
c. For both (a) and/or (b), the deduction in marks will be
applicable for the whole

assessment.
* for further details Refer to MEC Student Academic Integrity
Policy in Student Handbook.
2. Late Submission Regulations:
It is the students’ responsibility to check all relevant timelines
related to assessments.
As per the Assessment Policy at MEC, late submissions are
allowed for one week (5 working days)
for all GFP modules with a penalty. In such cases, a deduction
of 5% of the marks obtained for the
submitted work shall be imposed for each working day
following the last date of submission
till the date of actual submission. Assessment documents
submitted beyond a period of one
week (5 working days) after the last date of submission will not
be accepted and will be awarded

a zero for that assessment. In cases where the submission has
been delayed due to extenuating
circumstances, the student may be permitted to submit the work
without imposing the late
submission policy stated above. The extended period of
submission will be one week from the
original last date of submission. In such cases, the student is
expected to submit the supporting
certificates on or before the original last date of submission of
the assessment and the decision
of extension rests with faculty responsible for the assessment
.The late submission policy shall be
applied if the student fails to submit the work within one week
of the original last date of
submission.
Students may contact their teachers for clarification on specific

details of the submission time if
required.
3. Research Ethics and Biosafety Policy
To protect and respect the rights, dignity, health, safety, and
privacy of research subjects involved
including the welfare of animals and the integrity of
environment, all student projects are
expected to be undertaken as per the MEC Research Ethics and
Biosafety Policy. Accordingly the
following shall apply.

• Research and other enterprise activities shall be conducted by
maintaining the high ethical
standards consistent with national and international standards
and conventions.
• Any research at MEC that is categorized as high-risk research
shall be subject to review and
approval by the Research Ethics and Biosafety Committee.
• Research activities involving collection of human or animal
tissues and manipulation of microbial,
animal or plant cells shall be subject to review and approval by
the Research Ethics and Biosafety
Committee.
• Participants involved in research must be informed about the
purpose of research and intended
uses of research findings. Written consent must be obtained
from people involved prior to the

commencement of research.
• Data obtained from participants must be treated with high
confidence and should be used only
for the intended purpose of research.
Assessment Evaluation Criteria
Classification
And % Range <to be given
as per requirement>
Reflection and critical
analysis.
Knowledge and
Understanding/
Application of Theory
Evidence of Reading Referencing and

Bibliography
Presentation, Grammar
and Spelling
Outstanding
Highly competent
analytical skills and
reflective practice,
demonstrating personal
learning and growth,
insight into required
professional values and
principles and professional
development planning.

Extensive knowledge and
depth of understanding of
principles and concepts
and /or outstanding
application of theory in
practice.
Evidence of reading an
extensive range of
educational
literature/research and
where applicable
workplace strategies,
policies and procedures.

Accurate referencing and
bibliography correctly
using appropriate
referencing style
Excellent presentation,
logically structured, using
correct grammar and
spelling, excellent cross-
referencing and links to
supporting evidence
Excellent

Strong analytical skills and
reflective practice used,
professional values,
principles and
competencies and
professional development
planning.
Excellent knowledge and
understanding of principles
and concepts and /or

excellent knowledge and
understanding of the
practice
Evidence of reading a wide
range of educational
where applicable,
workplace strategies,
policies and procedures.
Appropriate referencing
and bibliography correctly

using appropriate
referencing style
Good presentation,
competently structured,
using correct grammar and
spelling, clear and easy to
use links to supporting
evidence
Very Good Quality
Good use of analytical skills
and reflective practice

principles and
competencies and
planning.
Good knowledge or key
and/or good knowledge of
the application of theory in
practice
Evidence of reading a good

range of educational
where applicable workplace
strategies, policies and
procedures.
Generally well referenced
with correct use of the
appropriate referencing
style
Reasonable presentation,
completely structured,
acceptable grammar and
spelling, acceptable links to

supporting evidence
Good (Acceptable)
Acceptable use of analytical
skills and reflective practice
principles and
competencies and
planning.

Acceptable knowledge of
key principles and concepts
and/or knowledge of the
practice
Evidence of reading an
appropriate range of
educational
where applicable, relevant
workplace policies and
procedures
Adequate referencing.

Generally accurate use of
style
Adequate presentation and
structure, acceptable
grammar and spelling,
adequate links to
supporting evidence
Adequate/ Satisfactory
Adequate use of analytical
skills and reflective practice

Adequate knowledge of key
and/or satisfactory
Evidence of minimal
reading of educational
where applicable relevant
Adequate referencing.
Appropriate referencing
style used but may contain
some inaccuracies.
Weak presentation ,

satisfactory structure,
grammar and spelling, links
to supporting evidence
principles and
competencies and

planning.
evidence of the application
of theory in practice.
workplace policies and
procedures
Weak /Poor
(all learning outcomes not
adequately met)
Little use of analytical skills
and reflective practice

competencies and/or
planning. Professional
values and principles not
reflected in the submission.
and/or
Insufficient/no use of
analytical skills and
reflective practice

competencies and
planning
Little evidence of
knowledge of key
principles or concepts
and/or little evidence of
the application of theory in
practice
and/or
No evidence of knowledge
of key principles or

concepts and/or no
evidence of application of
theory in practice
Little or no evidence of
reading outside of the
course textbook and/or
reference to relevant work
place policies and
procedures
and/or
No evidence of reading
outside of the course
textbook and/or reference

to relevant workplace
policies and procedures
Little or no referencing,
incorrect style, or very
inaccurate use of
style
Poor presentation,
grammar and spelling, links
to supporting evidence
and/or
Unacceptable

presentation, grammar
and spelling, structure is
very poor, links to
supporting evidence

Policy to tackle the social determinants of
health: using conceptual models to understand
the policy process
Mark Exworthy
Accepted 22 June 2008
Like health equity, the social determinants of health (SDH) are
becoming a key
focus for policy-makers in many low and middle income
countries. Yet despite
accumulating evidence on the causes and manifestations of
SDH, there is
relatively little understanding about how public policy can
address such complex
and intractable issues. This paper aims to raise awareness of the
ways in which
the policy processes addressing SDH may be better described,
understood and

explained. It does so in three main sections. First, it summarizes
the typical
account of the policy-making process and then adapts this to the
specific
character of SDH. Second, it examines alternative models of the
policy-making
process, with a specific application of the ‘policy streams’ and
‘networks’ models
to the SDH policy process. Third, methodological
considerations of the preceding
two sections are assessed with a view to informing future
research strategies.
The paper concludes that conceptual models can help policy-
makers understand
and intervene better, despite significant obstacles.
Keywords Policy process, social determinants of health, health

inequalities, research
methodology
‘What is striking is that there has been much written often
covering similar ground . . . but rigorous implementation of
identified solutions has often been sadly lacking.’ (Wanless
2004, p.3)
This quote was written about UK policy addressing the social
determinants of health (SDH) but is applicable to most high or
low and middle income countries. Despite mounting evidence
of the causes of health inequity, even in the latter countries,
attention on the policy process is a notable omission. This may
reflect the epidemiological emphasis on SDH research and/or a
lack of engagement between public health and policy analysts.

This article seeks to remedy that by closely examining the
nature of the SDH policy process, how it might be conceptua-
lized and researched.
Re-visiting the policy-making process
The term ‘policy’ is so widely used that it often obscures
meaning. Searching for definitional clarity can be misleading.
Its various uses denote the significance attached to it by mult-
iple stakeholders (Hogwood and Gunn 1989; Buse et al. 2005)
KEY MESSAGES
� Social determinants of health (SDH) represent major
challenges to health policy-makers in all countries.
� Models of the policy process are often ill-suited to local
contexts and the nuances of SDH.
� A sensitive application of models such as ‘streams’ and

‘networks’ offers significant insights into the nature of SDH
policy
and the opportunities/constraints facing policy-makers.
� Understanding and explaining SDH policy processes need to
be undertaken sensitively, recognizing peculiar methodological
challenges.
School of Management, Royal Holloway-University of London,
Egham,
Surrey, TW20 0EX, UK. E-mail: [email protected]
Published by Oxford University Press in association with The
London School of Hygiene and Tropical Medicine
� The Author 2008; all rights reserved.
Health Policy and Planning 2008;23:318–327
doi:10.1093/heapol/czn022
318
Downloaded from https://academic.oup.com/heapol/article-
abstract/23/5/318/615803/Policy-to-tackle-the-social-

determinants-of-health
by guest
on 24 September 2017
and/or the multiple levels at which it is developed. A useful
way
of understanding ‘policy’ is in terms of context, content,
process
and power (Walt 1994). First, context is the milieu within
which interventions are mediated; it therefore shapes and is
shaped by external stimuli like policy. Second, content refers to
the object of policy and policy analysis, and may be divided
into
technical and institutional policies (Janovsky and Cassells
1996). Third, Wildavsky’s (1979) reminder that ‘policy is a

process, as well as a product’ is crucial because it draws
attention to the course of action over time. Finally, power
draws attention to the interplay of interests in negotiation and
compromise.
The ‘policy process’ is often presented as a linear, rational
process moving from formulation to implementation; for
example:
� ‘Politicians identify a priority and the broad outlines of a
solution . . .;
� Policy-makers . . . design a policy to put this into effect,
assembling the right collection of tools: legislation, funding,
incentives, new institutions, directives;
� The job of implementation is then handed over to a different

group of staff, an agency or local government;
� . . . the goal is (hopefully) achieved’ (UK Cabinet Office
2001,
p.5).
This is an over-simplistic view. The distinction between
formulation and implementation is rarely clear-cut; intentions
and action are often hard to distinguish. It may be more helpful
to view the ‘policy process’ as disjointed and ‘messy’. For
example, John (2000) argues that there is often no start or end
point, only a middle. Policies are developed within a pre-
existing context that effectively constrains new opportunities.
The legacy of former decisions creates conditions from which
policy-makers may find it difficult to diverge, a condition

known as ‘path dependency’ (Greener 2002). Most resource
decisions, for example, only consider marginal changes rather
than taking fundamental re-assessment of principles. Path
dependency limits the range or possibility of radical changes of
direction, at least in the short term—often called ‘increment-
alism’ (Lindblom 1959). This perspective also contends that the
policy process can often be static for relatively long periods,
only to be disturbed by moments of change—disjointed
incrementalism and punctuated equilibrium. As a result, the
policy process is characterized by (positive and negative)
feedback loops and rarely reaches completion. However, Clay
and Schaffer (1984), for example, demonstrate the ‘room for

manoeuvre’ that policy-makers can enjoy.
The health policy process is also characterized by other
features. First, policy decisions rarely take place at a single
point in time and can be protracted over months or even years.
It is therefore difficult to discern if/when a specific decision
was
made. Policy decisions often reflect a broad direction (despite
conflict) so as to mollify stakeholders’ concerns or to denote
their power. Second, policy-making rarely occurs in public but
rather behind ‘closed doors’, despite some attempts to make it
more transparent. Third, policy-making often results in no
decisions or non-decisions. The lack of (observable) action or
outcome may actually signify a complex set of forces that have

stifled a decision or prevented proposals from being enacted
(Lukes 1974). Finally, much of the evidence on the policy
process
originates from high income countries (HICs); there is thus an
empirical question as to whether typical approaches and under-
standing are valid in low and middle income countries (LMICs).
Questions about similar translations between demographic/
population and income groups may also be posed.
SDH offer an insightful case study of health policy processes
because they have in recent years assumed a more central place
in policy processes of many HICs and LMICs; previously,
policy
analysis has tended to overlook the issue in favour of other
policy imperatives. It is, therefore, instructive to learn how the

specific nuances of these complex phenomena are articulated
in the content, context and process of health policy processes.
Such a case study is significant because, on the one hand,
SDH are more prominent in topical debates about MDGs and
poverty reduction, and on the other, SDH are illustrative of
increasingly complex developments in policy process (such as
governance and internationalization). However, each aspect
that public policy in each country seeks to address is, more or
less, a particular configuration of issues. Practically, these
issues
need to be understood and explained by academics and by
policy-makers that they may assess the likely impact of SDH
policy.

Broadly, eight challenges to addressing SDH through public
policy can be identified. Defining clearly the features of SDH
helps to draw sharper implications for policy development and
implementation. First, SDH are multi-faceted phenomena with
multiple causes. Models of SDH are useful conceptual devices
to
identify the causal pathways which have differential impacts on
health (see Figure 1).
However, SDH models rarely offer policy-makers a clear
direction for policy development (Graham 2004). First, some
policy-makers believe that the lack of a ‘simple problem’
hinders the development of ‘simple policy solutions’ or that
policy is ineffective in the face of wider social forces (such as

globalization). Others see SDH as ‘invisible’ (Dahlgren and
Whitehead 2006, p.15). As a result, there has often been no
policy response to ‘act upon SDH’ or, where there has been
some attempt, a diffuse approach. This has often been
hampered by the lack of consensus among academics and
policy-makers about the policy solutions required.
Second, the life-course perspective (Blane 1999) presents a
challenge to policy-making processes whose timescales are
rarely measured over such long periods. The life-course
perspec-
tive posits that early life influences (say, upon diet or educa-
tion) have life-long impacts that will only be evident many
years hence. This perspective contrasts with the tenure of

elected and/or appointed officials (which is usually measured
in years, rather than decades), the electoral cycles in
parliamentary or presidential democracies (usually measured
from 5 to 7 years), and organizational reporting cycles (e.g. for
budgetary purposes usually measured annually). Moreover,
coalitions of interests in support of SDH policies may be
unsustainable over the time periods necessary to witness
significant change, thereby presenting a challenge to create
and sustain commitment to and involvement in the policy goals
and process. Partly as a result, attention of the public (often
supported by the media) and some practitioners has tended to
reinforce such short-term timescales. This second feature is

POLICY TO TACKLE SOCIAL DETERMINANTS OF
HEALTH 319
by guest
thus a challenge to integrate long-term approaches with short-
term organizational/political imperatives.
Third, SDH necessitate policy action across different organiza-
tions and sectors (not least, the health care sector) (Hunter
2003;
Gilson et al. 2007). Often, policy responses are only disease-
specific rather than addressing SDH. Inter-organizational and
inter-sectoral partnerships are critical to formulating and

implementing policy towards SDH. However, evidence shows
that partnerships at all levels are hampered by cultural,
organizational and financial issues (Lee et al. 2002; Sullivan
and
Skelcher 2002). Different values, different accountabilities and
performance measures/criteria, and different reasons for colla-
borating are among the challenges for partnerships. Moreover,
the ‘health’/SDH agenda may be marginal to collaborating
organizations, SDH being perceived as beyond their core
purpose.
It can also be argued that action on SDH requires intervention
beyond state/government, by civil society organizations or even
private sector agencies. Such collaboration regarding SDH is
likely

to be even more problematic.
Even within governments, inter-organizational collaboration
has often been poorly developed. Traditionally, government
agencies tend to be organized vertically (Ling 2002; Bogdanor
2005). For example, education ministries are largely focused on
running schools, health ministries on delivering health care
services, etc. Yet, such ‘silo’ or ‘chimney’ approaches are not
well suited to tackle cross-cutting issues. A strong coordination
role, say, across government or by an external (international)
agency might offset the ‘silo’ approach but the balance of
power
usually remains with ministries.
Fourth, SDH are one of many competing priorities for policy-

makers’ attention and resources. Economic, foreign or devel-
opment policies might take precedence over SDH, inter alia.
More specifically, SDH may be over-shadowed in the policy
process by health care itself. As most states take a prominent
role in the financing and/or delivery of health care to its
population (Saltman 1997), it is perhaps inevitable that states
take a close interest in such matters. However, this health care
focus is often to the neglect of health and SDH per se (Gilson
et al. 2007). That said, other spheres of policy (such as
education or transport) can be informed by SDH.
Fifth, SDH are so complex that the cause-effect relationships
are not readily apparent. Moreover, some evidence is equivocal

about these associations. For example, statistical correlations
are common in epidemiological studies which inform policy-
making, but they rarely demonstrate causation. Knowing and
understanding causal pathways is a first step in devising
appropriate policies but many gaps in knowledge remain,
especially in LMIC contexts. Attributing policy mechanisms to
their impact upon health can often be obscured because:
‘Policy cannot be intelligently conducted without an under-
standing of mechanisms; correlations are not enough’
(Deaton 2002, p.15).
As a result, policy levers (such as legislation and resource
allocation) are seen as blunt instruments in tackling SDH,
whose consequences are not, and sometimes cannot be,

ascertained with sufficient clarity.
Attribution of policy interventions to outcomes is problematic.
Such outcomes may not be evident for many years, if at all, as
indicated by the life-course perspective. Consequently, there is
often a reliance on ‘process’ measures as indicators of progress,
assuming that they are associated with outcomes. This may be
particularly problematic the higher the level of analysis, such as
macro-economic policy (Turrell et al. 1999), or as policy is
transferred from HICs to LMICS. Attribution may also pose
dilemmas for targets given the multi-faceted nature of policy
outcomes.
Sixth, the identification, monitoring and analysis of epide-

miological changes over time, is crucial to inform the policy-
making process. Yet, routine data are not always available, are
of poor quality or have been collected over insufficient periods
Figure 1 The main determinants of health.
Source: Dahlgren and Whitehead (1991).
320 HEALTH POLICY AND PLANNING
by guest
to aid policy-making (Center for Global Development 2006;
Exworthy et al. 2006). Data categorization by population groups
(e.g. ethnicity, gender) or geographically is often poor.

However, whilst data are necessary, they alone are not
sufficient to secure policy implementation.
Seventh, globalization and multi-lateralism are significant
factors in delivering ‘global public goods’ such as health (Chen
et al. 1999) but such goods have been influenced by the
changing role of the nation state in policy-making (Lee et al.
2002; Labonte and Schrecker 2007). Powers have been re-
located to supra-national organizations such as the European
Union, World Trade Organization, International Monetary Fund
and World Bank. In particular, these supra-national institutions
tend to promote a neo-liberal agenda (Raphael 2003).
Governments’ ability to shape and mould the SDH with the
goal of improving their population’s health is becoming limited

as many of the ‘causes’ of poor health (Wilkinson and Marmot
2003) no longer fall within their responsibility. They, therefore,
need to rely on influence and leverage in multi-national
networks. By contrast, decentralization to regions and cities
has had a similar effect on the policy-making capacity of
governments. Decentralization in HICs and LMICs can be seen
as an attempt to make public services more responsive to local
needs (and in that sense, improve intra-area/population equity).
However, despite its popularity, decentralization in LMICs and
HICs is rarely achieved in full or within parameters defined by
central government (Bossert 1998; Atkinson et al. 2002). As
such, decentralization might be seen as less of a threat to

national policy-making than globalization, since the implemen-
tation of the former lies mainly within governments’ control
These seven challenges of the contemporary policy process as
applied to SDH are summarized in Table 1.
The challenges demonstrate that, despite the growing volume
of evidence on SDH, understanding of the particular demands
of the policy process around SDH in particular contexts has
been limited. In short, despite the growing attention on SDH,
understanding of the policy process in particular contexts has
been missing. Policy models and frameworks can help in
developing the theory and practice of policy development to
tackle SDH.
Policy models and their application to

SDH
Conceptual models can provide tools to describe, understand
and explain policy processes. Such models are important for
two reasons. First, much health policy practice has been
developed (and researched) in HICs and ‘transferred’, often
uncritically to LMICs. However, the variability of context and
nuances of individual policies make generalizability proble-
matic. Exporting policies within or between countries is often
discounted on the basis that the ‘context’ is different and hence
lessons from host countries cannot be learnt. However, a focus
on conceptual models can obviate some of these problems by
addressing key issues such as power and resistance. By applying
concepts of the policy process, it is thus possible to discern

meanings and motives, similarities and differences in patterns
and practices across context. Second, as SDH present specific
challenges to the policy process, the configuration of SDH and
policy context in each country demands that typical policy
frameworks are adapted to local contexts.
Despite the extensive literature on this topic and for sake of
brevity, this article focuses on selective models as illustrations
of the ways in which they contribute to improved under-
standings of how the SDH policy process, specifically, may be
approached by policy-makers. The three models do represent,
however, major approaches within the extensive literature,
though they do not provide, by any means, a comprehensive
assessment:

1. streams
2. networks, and
3. stages.
’Streams’ model
This model is concerned with how issues get onto the policy
agenda and how proposals are translated into policy. Kingdon
(1995) argues that ‘windows’ open (and close) by the coupling
(or de-coupling) of three ‘streams’: problems, policies and
politics. The model (and its variants) has been applied to
analysis of policy change around health inequalities and SDH
(e.g. Exworthy et al. 2002; Sihto et al. 2006). This model is
especially pertinent to SDH because, in many (HIC and LMIC)

countries, SDH have struggled to reach the policy agenda, let
alone become implemented. This is despite mounting (epide-
miological) evidence (Wilkinson and Marmot 2003) and policy
proposals.
Problem stream
Conditions or issues (such as SDH) only become defined as
‘problems’ when they are perceived as such. Often, only those
‘problems’ which are (potentially) amenable to policy remedies
Table 1 Link between features of social determinants of health
(SDH) and the impact on policy-making
Features of SDH Impact on policy-making
Multi-faceted phenomena with multiple causes Coordinated
strategies are difficult to achieve
Life-course perspective Long-term approach does not match

policy timetables
Inter-sectoral collaboration and partnership Partnerships are
problematic
Dominance of other priorities SDH often neglected
Cause-effect relationships are complex; attribution difficulties
Attribution problems hamper policy; reliance on process
measures
Data Routine data that is of high quality, timely and available,
are often lacking
Globalization (and decentralization) Policy-making involves
more stakeholders at multiple levels,
hampering governmental action
HEALTH 321
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are recognized; many will remain unaddressed. The issues
might be brought to attention by:
1. Key events (such as crises or critical incidents) and/or
2. Publication of ‘evidence’ (such as research studies or
inquiries) and/or
3. Feedback from current policies (via the media or public
opinion).
The growing volume of research evidence has highlighted SDH
but many ‘policy-makers may even be unaware of the
magnitude and trends of existing inequities in health among
their people’ (Dahlgren and Whitehead 2006, p.16). This

underlines the fact that researchers are but one stakeholder
and evidence is just one source of information in policy
processes (Trostle et al. 1999). The lack of consensus about
evidence among the research community may hamper their
influence in defining the ‘problem’. The role of key events and
feedback (e.g. funding crises or negative public opinion) should
not be overlooked in accounting for the policy experience of
specific countries. Also, stakeholders or interest groups (e.g.
medical profession or community groups) might play a
prominent role in highlighting specific issues and bringing
them to the attention of policy-makers (often via the media).
The publication of a key research report [such as the UK

Acheson Inquiry (1998) on health inequalities or the World
Health Organization Commission on SDH] may be such a
prompt (Exworthy et al. 2003).
Policy stream
The multiple strategies and policies may be advanced not just
by civil servants or professionals but also by interest groups.
Some may be ‘kite-flying exercises’ (testing support for
particular strategies) or concrete proposals. However, for any
strategy to be enacted, it must meet a minimum threshold of:
1. Technical feasibility,
2. Congruence with dominant (socio-political) values, and
3. Anticipation of future constraints of the strategy being
proposed.

Many SDH policy proposals may fail to reach these thresholds
and so fail to offer coherent solutions. For example, policies
may not be technically feasible. Though desirable, policies may
not be (proven) effective. Moreover, addressing SDH or health
inequalities may run counter to dominant values and shifting
political values would also threaten further this criterion. The
paucity of evidence about cost-effectiveness of policy solutions
(e.g. Wanless 2002) illustrates this aspect as it might militate
against the relatively newly dominant paradigm of proving
impacts in this way (Davies et al. 2000). Future constraints may
include, for example, the (unintended) consequences of
tackling a particular condition (e.g. obesity).

Politics stream
This refers to the lobbying, negotiation, coalition building and
compromise of local, national and international interest groups
and power bases. In terms of SDH, such political debates can
be vociferous, as they often challenge the power of existing
social, economic and political systems or practices. For
example,
in the UK during the 1980s and early 1990s, (right-wing)
governments rejected the notion of health inequalities (Berridge
and Blume 2002); this effectively stifled any policy
development
towards SDH.
Coupling the streams
These three streams may be coupled by chance factors, political

(e.g. elections) or organizational cycles (e.g. staff turnover), or
by the actions of a policy entrepreneur. The ‘policy entrepre-
neur’ (such as a government minister, leading doctor, civil
servant or academic) facilitates the coupling process by
investing their own personal resources (namely, reputation,
status, time):
‘Policy entrepreneurs are people willing to invest their
resources in return for future policies they favour’ (Kingdon
1995, p. 204).
De-coupling may also occur if/when conditions in each stream
are not met. For example, the policy entrepreneur may move
position. Equally, there may be a change of government or

other issues assume greater importance. The ‘policy window’
will, therefore, close. The ability of policy-makers to ‘fix the
window open’ (by integrating SDH policy into ‘mainstream’
policy processes) will largely determine the long-term viability
of the policy.
Coupling the streams is not guaranteed; failure may be more
likely (Wolman 1981). Failure to join these streams can
result in disillusionment and claims that policies are purely
symbolic (Edelman 1971). For example, the inability to couple
‘streams’ (in terms of SDH) may be indicative of wider
constraints:
‘Many declarations to tackle inequities . . . appear to be
merely rhetorical, as they have not been followed by any

comprehensive policies and actions to address the problem’
(Dahlgren and Whitehead 2006, p.16).
Other policy models adopt a similar ‘streams’ approach,
involving the conjunction of separate dimensions. Webb and
Wistow (1986) and Challis et al. (1988) argue that three
streams (policy, process and resource) need to be conjoined to
complete the policy process.
1. The policy stream is concerned with policy aims and
objectives;
2. The process stream is concerned with policy means (the
instruments or mechanisms to achieve the policy ends);
3. The resource stream is concerned with the human, financial

and material resources needed to facilitate the process
stream.
A ‘successful’ policy will comprise clear objectives,
mechanisms
that achieve those objectives and the resources to facilitate the
process (Powell and Exworthy 2001). However, aspects of
technical and political feasibility make the process stream
highly problematic for SDH policy. Moreover, SDH must
compete for resources (including staff time and finances)
among other priorities.
Another related model by Richmond and Kotelchuck (1991)
concerns the development of ‘health policy priorities’ by

by guest
integrating the evidence base, social strategies and political will
which equates with a ‘public mandate for policy action’
(Nutbeam1998, p.31). Similarly, Nutbeam (2004) claims that
policy implementation is most likely when there is a synthesis
of plausible evidence, political vision and practical strategies
(see also Petticrew et al. 2006).
’Networks’ models
The policy process rarely operates in isolation but rather
through networks of stakeholders, each with their own

interests and motivation. These networks involve interactions
between communities of stakeholders (inside and beyond the
policy process):
‘Although decision-making bodies have some room for
manoeuvre, they usually depend on each other, and thus
form close relationships within a policy sector’ (John 2000,
p.83).
Kickert et al. (1997) argue that policy-making takes place in
‘networks consisting of various actors (individuals, coalitions,
bureaux, organizations), none of which possesses the power to
determine the strategies of other actors’ (p.9).
Whilst networks might develop high degrees of trust and

dependence, they can equally exclude others from the policy
process. Close network relations can also foster learning and
development as they are grounded in practical experience. As
such, networks can foster bottom-up policy developments.
These broad principles are illustrated by two main ‘network’
models: (1) policy and issue networks, and (2) the advocacy
coalition framework (Hudson and Lowe 2004).
(1) Policy and issue networks
The distinction between policy networks and issue networks
revolves around the degree to which stakeholders are involved
directly in the policy process. Four features characterize
networks:
� Membership (number and type of members),

� Integration (frequency, continuity and consensus),
� Resources (their distribution), and
� Power (balance between members) (Marsh and Rhodes
1992).
Policy networks comprise civil servants, politicians and co-
opted
members (for example, academic experts). These networks
involve stable relationships among a limited group of stake-
holders with shared responsibility and high degree of integra-
tion. By contrast, issue networks are oriented around specific
‘issues’ and tend to comprise loose, open connections amongst
a shifting group of stakeholders. Heclo (1978) proposed that
issues are not defined by members’ interests but rather the

issues themselves become their interests (Nutley et al. 2007,
p.108).
Applied broadly to SDH, issue networks (relating, say, to
public health or community groups), which seek to raise
attention to the ‘problem’, promoting solutions and lobbying
policy-makers, have become commonplace. An ‘SDH policy
network’, by contrast, has traditionally been absent or poorly
developed, as it implies cross-departmental working (which has
typically not been the modus operandi of governments). There
are
signs that such networks are becoming more established as
(some) governments begin to take action on SDH (e g. Judge
et al. 2005; Stahl et al. 2006), partly due to the influence of

issue
networks and supra-national institutions (e.g. World Health
Organization and European Union). A schematic summary
indicates that ‘SDH policy networks’ tend to be small, weak and
poorly integrated (though the assessment is dynamic and
peculiar to each country) (Table 2).
Across any government, there are potentially several policy
networks relating to SDH. These networks will inevitably
involve trade-offs, say, between public health and health-care,
between ministries, between SDH policies and routine service
delivery, and between equity and other principles (such as
efficiency). In short, there are (greater or lesser) signs of an
uneasy integration of issue networks into policy networks, as

SDH become established as a legitimate sphere of government
competence in many countries. However, as this happens, new
patterns within policy networks are emerging, although the
SDH discourse has yet to fully permeate all corners of any
government (Exworthy et al. 2003).
(2) Advocacy Coalition Framework (ACF)
Sabatier (1991) (among others) has argued that the policy
process involves the formation and maintenance of complex
coalitions (networks) of interest as well as the top-down
prescription (for example, in terms of achieving ‘perfect
implementation’) (Hudson and Lowe 2004, p.212).
Sabatier’s ACF model views the policy process as a series of

networks which are composed of all the organizations and
Table 2 Assessment of policy networks and issue networks in
relation to social determinants of health (SDH)
Network
characteristic
Assessment criteria in
relation to SDH Policy networks Issue networks
Membership 1) Number of participants
2) Types of interest
1) Low
2) Focused
1) High
2) Highly varied
Integration 1) Frequency
2) Continuity
3) Consensus
1) Low but growing

2) Low
3) Weak especially regarding interventions
1) High
2) High/medium
3) Weak
Resources Distribution Mainly hierarchical Loose affiliation
Power Balance of power Strong. Balance of power tilted
towards government
ministries and towards health-care
Weak but varied.
Source: Adapted from Marsh and Rhodes (1992).
HEALTH 323
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stakeholders (inside and beyond the policy process) with a
particular interest in that policy sphere.
‘Whatever the motivation for action, it is essential to find
potential allies and partners sharing common or converging
values and objectives, or to find acceptable trade-offs when
conflicting interests are unavoidable’ (Ritsatakis et al. 2006,
p.146).
These networks comprise a ‘coalition of advocates’ and are
termed ‘sub-systems’. They are defined by a set of core values
and beliefs which are resistant to changing ideas and new
policies. Although sub-systems are constantly involved in

examining and learning about their policy environment,
change is only likely to occur when a significant amount of
those values are challenged successfully.
It has become apparent that, over the last decade or so,
coalitions of advocates have been forming in many countries
around a set of core beliefs (relating to SDH) which are
challenging existing dominant values. Such beliefs have been
heavily shaped by the challenge of the SDH research paradigm,
as in the case of the UK’s Acheson report (1998). According to
Sabatier, the impact of such shifts in core beliefs upon policy
might only be apparent after a decade or more. Thus, for SDH
policy programmes which have only recently been established,
it is too early to judge their success. New coalitions may not

always be effective as resistance to new paradigms and
approaches might be expected from (coalitions of) interests
within and beyond the policy process.
’Stages’ models
Some commentators have sought to clarify and explain the
complexity of the policy process by developing models which
identify a linear progression through stages of policy develop-
ment. They offer a heuristic value in understanding the
evolution of policy and may help identify, for example,
potential points at which policy may falter through the use of
(negative) feedback loops (such as implementation failure,
leading to a re-formulation of the ‘problem’).

The most commonly applied example of ‘stages’ in relation to
SDH is by Dahlgren and Whitehead (2006) who identify seven
stages towards action (Figure 2).
Ritsatakis and Jarvisalo (2006) offer a variation of the
Dahlgren and Whitehead ‘stages’ model:
1. Reaching policy-makers and the public (raising awareness);
2. Securing the information (such as international databases,
presentation and discussion, parliament);
3. Policy formulation and implementation (inter-sectoral com-
mittees, leadership, consensus conferences, formal consulta-
tions in drafting legislation, public referenda, informal
contacts);
4. Seeking partnerships and alliances; and

5. Provisions for implementation.
No single policy model offers a fully comprehensive description
or understanding of the policy process as each answers
somewhat different questions. The selection and appropriate
application of these models to health policy analysis is crucial
in understanding and explaining the ways in which SDH are
addressed in specific national contexts.
Conducting research on the SDH
policy process
Understanding better the policy process is a crucial step in
applying it to the SDH context. However, it is also important to
understand how such processes affect the conduct of research
about the policy process. Five considerations are noteworthy

(Table 3).
First, the long-term nature of policy development (arising
from the life-course perspective and engrained nature of SDH in
society) presents a challenge for research which is often funded
on a short-term basis in the hope of seeking quick answers and
remedial solutions. Tracing policy developments over the long-
term involves different methodologies too. For example, as
outcomes may not be observable for some time, intermediate
measures of progress are often sought.
Second, tracing causes and effects of policies presents attrib-
ution difficulties. Tracking the pathways from epidemiological
data to policy responses and their impact is complicated by the
‘open systems’ within which SDH operate. Counter-veiling

forces (such as the economic climate or globalization) might
Measurement
Recognition
Awareness raising
Concern Denial/indifference
Mental block
Will to take action
Isolated initiatives
More structured developments
Comprehensive coordinated policy
Figure 2 Action spectrum on health.
Source: Dahlgren and Whitehead (2006, p.95).
Table 3 Researching the social determinants of health (SDH)
policy

process
Features of SDH
policy-making Impact upon researching the policy process
Long-term perspective � Long-term research
� Search for process measures
Attribution � Programmes of research,
examining range of issues
� Development of monitoring techniques
Non-decisions � Participant-observation
� Policy ethnography
Multiple agencies
and stakeholders
� Research into cultural, organizational
and political practices
Multiple policy
programmes

� Programmes of research, examining
range of issues
� Long-term research
by guest
undermine or counteract policy effects in unintended or
unobservable ways. Methodological responses to such dilemmas
might include research projects examining discrete interven-
tions but this loses the inter-connectedness of SDH (Milward
et al. 2003). Research programmes (with several projects) might

mitigate this, but doing so on an international scale is often
prohibitive.
Third, the opaqueness of policy-making (and especially non-
decisions) is problematic for researchers. Gaining access to
organizations is a perennial issue for researchers but it is
perhaps even more difficult to observe policy-making processes
in action. Moreover, the ways in which decisions ‘emerge’
(rather than taking place at a single moment and often
unobservable to the researcher) are particularly problematic.
Participant-observation is a strategy that is seemingly easy to
adopt but difficult in practice. There is perhaps understandably
a reliance on semi-structured interviews and documentary
analysis.

Policy ethnography is a developing methodology which
involves long-term immersion in a policy domain (Flynn et al.
1996; Exworthy et al. 2002). Nonetheless, it is difficult to
construct an authentic account of the policy-making process
that captures its nuances and complexity over the long-term.
Becoming too closely associated with policies can create a bias
as researchers can become apologists for the policy that they are
investigating. Decisions and non-decisions taken elsewhere may
thus become less apparent. Case studies and witness seminars
(involving stimulated recall of the key actors; Berridge and
Blume 2002) can also be useful techniques.
Fourth, capturing the views of multiple stakeholders and

tracing the influence of each organization’s practices and cul-
ture upon the policy process are complex tasks and time-
consuming. Studies of inter-organizational relationships have
a long lineage and researchers should draw on this extant
knowledge (Ferlie and McGivern 2003). However, the scale of
the task in terms of SDH should not be under-estimated given
the multiple agencies that could (potentially) be involved in
SDH policy (Nutbeam 1998).
Fifth, by its very nature, tackling SDH implies a multi-faceted
approach. Whilst much public policy tends to focus on single
strategies for particular population groups in specific circum-
stances, there is a need to examine the inter-connectedness of
components of SDH. The breadth of such research is daunting

and therefore requires large-scale, longitudinal research pro-
grammes (including policy research). This observation implies a
multi-disciplinary approach which is often antithetical to the
organization of universities, their criteria for appointments and
tenure, and the publication of research. Large-scale research
programmes may offer insights into the ways in which
international institutions are shaping the cross-national
causes of SDH; whether political action will be forthcoming
to address SDH globally is arguable.
Conclusion
Partly as a result of methodological difficulties, there is often
a search for conceptual development and theoretical elabo-
ration in health policy research. The policy process has been

described as an exercise in ‘collective puzzlement’ (Heclo and
Wildavsky 1974, p.305). In puzzling about possible policy
options available to policy-makers, there is an implicit
imperative for making choices and for understanding the
ways in which policy-makers learn from themselves (e.g.
Freeman 2006; Marmor et al. forthcoming). Conceptual
models are useful techniques in such learning.
This paper has sought to raise awareness of the ways in
which policy towards SDH may be better described, understood
and explained. By identifying the components of the policy
process and the ways in which features of SDH require the
adaptation of traditional approaches, it is possible to apply

conceptual models which offer new insights about SDH policy-
making. Researchers must therefore adapt and apply exist-
ing methodologies to the specific nuances of SDH policy.
Together, conceptual models and appropriate methodologies
may contribute to improved policy-making which may, in
turn, ameliorate conditions for many of the poorest across the
world.
Acknowledgements
Research for this article was conducted by the author as a part
of the Measurement and Evidence Knowledge Network of the
WHO Commission on the Social Determinants of Health, of
which he is a member (http://www.who.int/social_determi-
nants/knowledge_networks/en/index.html). He is grateful to

members of the Knowledge Network, WHO representatives
and participants at the Health Policy Methodology Workshop
(sponsored by ODI in London in May 2007) for their
constructive comments. The views of this article do not neces-
sarily represent the M&E Knowledge Network, the Commission
or the WHO.
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HEALTH 327
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TITLE OF ARTICLE:
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