About the CSDH Framework

About the Framework

This framework was developed by Solar and Irwin (2010), and it was adopted by the World Health Organization’s Commission on Social Determinants of Health (CSDH). The framework illustrates the different types of the social determinants of health, and the causation relationship between these determinants and health. The framework also helps in prioritizing policy interventions to address healthcare issues effectively and efficiently. 

There are two types (levels) of the social determinants of health: The structural determinants and the intermediary determinants.

The Structural Determinants
The Socioeconomic and Political Context produces and maintains the social hierarchies through public policies, political and social institutions, the labor market, and the educational system. This context produces the social hierarchies through a set of structural mechanisms, including income, education, occupation, social class, gender, and ethnicity. These mechanisms, the context that produces them, and the resulting socioeconomic position are called the social determinants of health. They determine differences in people’s exposure and vulnerability to another type of determinants that are called the intermediary determinants of health (Solar & Irwin, 2010).

The Intermediary Determinants
The intermediary determinants of health have a direct impact on health as they determine the vulnerability and exposure to factors that affect people’s health. These determinants include material circumstances; psychosocial circumstances; behavioral factors, biological factors; and the health system (Solar & Irwin, 2010):

  • Material circumstances include housing, neighborhood quality, financial capacity of people, and the physical work environment. 
  • Psychosocial circumstances include the factors that cause stress, such as stressful relationships and the lack of social support. 
  • Behavioral factors include nutrition, physical activity, and tobacco and alcohol consumption.
  • Biological factors include genetic factors that could cause diseases or different types of disabilities. 
  • The health system factors include the accessibility and the quality of healthcare services.
  • The social cohesion and the social capital factors refer to the social relationship that bring benefits and support for people or lack thereof. This type of determinants has characteristics of both the structural and the intermediary determinants.


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