Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Scand J Public Health. 2022 Nov;50(7):1047-1058. doi: 10.1177/14034948221113147. Epub 2022 Sep 8.
The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches.Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models - including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.
需要可视化人口健康决定因素的复杂性及其相互作用,这激发了彩虹模型的发展。在本篇评论中,我们追溯了该模型的各种变体是如何出现的,包括 Haglund 和 Svanström(1982 年)、Dahlgren 和 Whitehead(1991 年)以及 Östgöta 模型(2014 年)的初始模型,我们还说明了这些模型如何在公共卫生领域及其它领域产生了影响。所有这些模型都与北欧有着密切的联系,因此是公共卫生领域北欧贡献的重要组成部分。此外,这些模型还为公共卫生领域的其他北欧领导范例提供了支持和便利,包括解决健康不平等问题和设计新的卫生政策方法的实际努力。除了记录彩虹模型的出现及其当代的广泛用途之外,我们还研究了针对这些模型的一系列批评——包括在方法学发展和范围方面的局限性。我们提出,现在是时候更新通用健康决定因素模型了,该模型阐明并保留了旧模型的核心价值,同时认识到过去几十年来我们对健康决定因素的理解所发生的发展。我们以一个通用模型为例,该模型满足健康决定因素模型的一般目的,同时为未来进一步调整以及针对特定地点或特定背景的调整保留必要的范围,无论是在教育、研究、健康促进等领域。