Spirit of John Snow. A multi-dimensional, cross-disciplinary, multi-actor conceptual framework, used as a tool to improve and maintain public health

The ‘social determinants of health' concept is well understood and now commonly used. Health is indeed not just a consequence of chance or choice. Its determinants are also not only social. UNICEF developed the concept of the ‘immediate', ‘underlying' and ‘basic' causes of disease and well-being. This concept has been further developed by the World Cancer Research Fund/ American Institute for Cancer Research, in its 2009 report on policy and action for cancer prevention, in a broad public health context. The conceptual framework used in this report – and in executive summaries prepared for Latin America and Brazil in partnership with the Pan American Health Organization and the Brazilian National Cancer Institute, and for the US in association with APHA – includes economic and physical environmental as well as social and personal dimensions. It is applied at global, national, local and personal levels and includes drivers of public health that cannot yet be quantified, such as economic globalization and climate change. It is used as a method to engage relevant actors synergistically, including international bodies, government, civil society organizations, industry, the media, schools, workplaces and institutions, health and other professionals, and people as members of households and communities and citizens as well as individuals. This presentation will give results from various studies that show how the system works. It will apply the framework to examples where the best available evidence can be progressed to rational public health policies and effective actions, where there is an urgent need.