Module Wrap-Up and Exercise

Thinking in Systems

Thinking about determinants of health can also be considered as thinking in systems and scenarios. It’s a process of evaluating external forces that influence how a policy, project, or plan might bear in reality.

For example, there are many positive benefits to a new housing project, however to state that it has a positive health impact due to increased employment opportunities and the quality of housing is healthier can be a misnomer.

Some points that challenge the idea that housing is inherently healthy ignores issues such as:

• In modern building materials there are a number of volatile organic compounds found which can cause inflammatory responses and contain endocrine disruptors;

• the quality and quantity of tenure for those that rent is crucial given the psychosocial stress people experience from issues such as fear of eviction and potential homelessness;

• and whether the types of homes being made reflect the cultural realities of modern life - such as multi-generational households - leading to potentially adverse household experiences.

Equally, when new employment is a ‘positive indicator’ of population health outcomes it has to be assessed through critical lenses:

• What are the conditions of employment, are they fixed contract hours with employee rights or is it through zero-hour contracts that put stress on individuals?

• How does the employment contribute to community wealth building?

• Does the employment offer substantial skills training?

These factors will more than often relate to broader structural determinants such as the influence of private sector lobbying or policy-led investment in services.

Without these issues being addressed more accurately the promise of a direction of good health can in fact lead to a different set of health problems.