Table 1 Mechanistic assumptions and their application to social determinants of healtha
Assumption | Description | How the assumption circumvents complexity of health inequities |
|---|---|---|
Reductionism | Assumes the whole system can be understood by identifying, describing and analysing all of its constituent parts | Breaks social determinants of health into separate, distinct factors (rather than a set of complex intersecting factors) Draws attention to symptoms or expressions of root causes that are more immediately visible (e.g. considering ‘race’ a determinant of health instead of ‘racism’) |
Linearity | Assumes that (1) output changes proportionally with input, and (2) the effect of combined inputs can be understood and predicted by dissecting the input–output relationships of individual components, or a direct summative and predictive cumulation of constituent parts | Simplifies interconnectedness Justifies use of proxy indicators that reflect symptoms rather than causes of health inequities (e.g. monitoring maternal and child mortality rates as indicators of equity) |
Hierarchy | Assumes central power and control, which diffuses systematically from proximal to more distal parts | Places responsibility for acting on health within individuals or groups, rather than society Legitimises a focus on health damaging behaviours rather than health damaging conditions, systems or structures |