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The relationship between health and other social conditions is so
complicated that even designing a visual model to represent it
poses a significant challenge. In this issue of Preventing Chronic
Disease (PCD),
we explore social determinants of health in the broad context in which
communities operate, and the editorial from our editor in chief
describes various models that have been used to encompass these
interactions. Models ranging from concentric circles to inverted
pyramids to causal webs define linear, two-dimensional modes of
operation. But the interactions among early childhood
development, globalization, health systems, urban settings, women and
gender equity, social exclusion, employment conditions, priority public
health conditions, and measurement and evidence — the nine areas of
concentration established by the World Health Organization Commission on
Social Determinants of Health (1) — suggest a visual model more closely
approximating the three dimensions in which these elements exist and
interact.
The cover image for this issue of PCD presents such a
model, a cluster of bubbles representing various factors affecting health
and designed using computer imaging software. As Wilcox writes in her
editorial, “A single bubble interfaces with many others, and if one bubble
pops, the surface tension and connectivity of the others change throughout
the cascade” (2). Represented as influences, the bubbles in this model
affect individuals both directly and indirectly, not only through the
companion bubble’s interface but also through the companion bubble’s
connections to other surfaces. Additionally, catastrophic natural or
political events can impact the cascade so that all systems will change, and
the individual will be caught up in these forces rather than be their focus. The cascade properties
illustrate the dynamic consequences, both intended and unintended, that may
result from social policy interventions.
References
Commission on social determinants of health. London (UK): Commission
on Social Determinants of Health, World Health Organization; 2006.
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