This is a three-page document consisting of excerpted quotations and two figures from A Conceptual Framework for Action on the Social Determinants of Health by Orielle Solar and Alec Irwin, World Health Organization, 2010. It is intended as a summary of key principles and concepts.

1. 1
Two Conceptual Challenges for Public Health Equity Champions:
Understanding Structural Vs. Intermediary Determinants of Health,
and Power
Source of selected quotes and two figures: Solar, O., & Irwin, A. (2010). A CONCEPTUAL
FRAMEWORK FOR ACTION ON THE SOCIAL DETERMINANTS OF HEALTH social
determinants of health discussion paper 2 (policy and practice) Accessed January 21, 2015 at
www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf
(Figure
page
6)
…conflating
the
social
determinants
of
health
and
the
social
processes
that
shape
these
determinants’
unequal
distribution
can
seriously
mislead
policy.
(page
5
emphasis
added)
The
role
of
social
position
in
generating
health
inequities
necessitates
a
central
role
for
a
further
two
conceptual
clarifications.
First,
the
central
role
of
power….The
central
role
of
power
in
the
understanding
of
social
pathways
and
mechanisms
means
that
tackling
the
social
determinants
of
health
inequities
is
a
political
process
that
engages
both
the
agency
of
disadvantaged
communities
and
the
responsibility
of
the
state.
(page
5,
emphasis
added)

2. 2
Second,
it
is
important
to
clarify
the
conceptual
and
practical
distinction
between
the
social
causes
of
health
and
the
social
factors
determining
the
distribution
of
these
causes
between
more
and
less
advantaged
groups.
The
CSDH
[the
World
Health
Organization
Commission
on
the
Social
Determinants
of
Health]
framework
makes
a
point
of
making
clear
this
distinction.
(page
5
emphasis
added)
The
most
important
structural
stratifiers
and
their
proxy
indicators
include:
Income,
Education,
Occupation,
Social
Class,
Gender,
Race/ethnicity
(page
6
emphasis
added)
The
vocabulary
of
“structural
determinants”
and
“intermediary
determinants”
underscores
the
causal
priority
of
the
structural
factors.
(page
6
emphasis
added)
The
CSDH
framework
departs
from
many
previous
models
by
conceptualizing
the
health
system
itself
as
a
social
determinant
of
health
(SDH).
The
role
of
the
health
system
becomes
particularly
relevant
through
the
issue
of
access,
which
incorporates
differences
in
exposure
and
vulnerability,
and
through
intersectoral
action
led
from
within
the
health
sector.
The
health
system
plays
an
important
role
in
mediating
the
differential
consequences
of
illness
in
people’s
lives.
(page
6
emphasis
added)
…the
political
nature
of
the
endeavour
needs
to
be
an
explicit
part
of
any
strategy
to
tackle
the
SDH.
(page
7
emphasis
added)

3. 3
(highlight
added,
Figure
page
8)
Arguably
the
single
most
significant
lesson
of
the
CSDH
conceptual
framework
is
that
interventions
and
policies
to
reduce
health
inequities
must
not
limit
themselves
to
intermediary
determinants,
but
must
include
policies
specifically
crafted
to
tackle
the
social
mechanisms
that
systematically
produce
an
inequitable
distribution
of
the
determinants
of
health
among
population
groups
(see
Figure
B).
To
tackle
structural,
as
well
as
intermediary,
determinants
requires
intersectoral
policy
approaches.
(page
7
emphasis
added)
Prepared
by
Jim
Bloyd,
MPH
Cook
County
Department
of
Public
Health
jbloyd@cookcountyhhs.org
(708)
633-­‐8314
Submitted
January
21,
2015
to
the
Region
V
HRSA
Collaborative
Improvement
and
Innovation
Network
to
Reduce
Infant
Mortality
(ColIN),
and
the
Illinois
Department
of
Public
Health
ColIN
Illinois
Social
Determinants
of
Health
Committee