The Common Risk Factor Approach (CRFA) to Oral Health Promotion
Determinants of Health

Description and Identification of the Social Determinants for Disease

Health is an amalgamation of many factors. The Dahlgren and Whitehead's model (1991) depicted in Figure 3 shows a core of individuals grouped together with some of the non-modifiable risk factors for disease such as age, gender and heredity.⁹ Radiating from the center are concentric arches of the determinants, the risk factors, affecting health. Dahlgren and Whitehead described these layers as the “policy rainbow.” These determinants not only interact with the individual but interact with each other in a complex relationship. The wider bands of determinants, those outside the social and community networks, are characterized as the “circumstances in which people are born; grow up, live, work, and age, as well as the systems put in place to deal with illness.”¹⁰ Described as “the causes of the causes,”¹¹ these determinants affect the ability of an individual to attain and maintain health. The wider arches involve issues such as health policies, access to care, and conditions under which people live and work.