October 19 2015

A new Prevention Institute (PI) report, Moving From Understanding to Action on Health Equity: Social Determinants of Health Frameworks and THRIVE, presents an overview of Social Determinants of Health (SDOH) frameworks and discusses how their updated THRIVE tool has incorporated the field’s collective knowledge on SDOH. This work builds off their U.S. Office of Minority Health (OMH)-funded cooperative agreement with the National Network of Public Health Institutes.

PI first developed Tool for Health and Resilience in Vulnerable Environments (THRIVE) in 2002, with funding from the OMH and the California Endowment. Since then, the public health community has created many more frameworks on the factors that shape health outcomes outside the healthcare system—i.e., the social determinants of health, or SDOH.

According to the World Health Organization (WHO), SDOHs are largely understood as the broad set of factors that influence health outcomes directly and shape community environments. These factors reach far beyond the healthcare system, and include structural drivers, such as racism, and the conditions of daily living – the community determinants of health. PI is working with WHO’s SDOH team to explore the use of their equity tools and updated THRIVE approach as a resource for advancing community efforts in other countries.

Global, national and local understanding of the factors that influence health, safety, and health equity has deepened significantly over the past decade. The paper highlights similarities among and differences between SDOH frameworks, and provides examples of how they are influencing local, regional, and national health and public health initiatives.

Among the report’s key findings include:

  • The increase in the number of SDOH frameworks reflects a growing collective understanding of the determinants that must be addressed to promote health and safety and achieve equitable outcomes.
  • While there are significant similarities among the frameworks, there are also some useful variations.
  • Understanding of how elements outside of the healthcare system impact health and safety outcomes and inequities in these outcomes has fueled new research, literature, frameworks, language, policies, and practice.
  • Many frameworks provide important contributions. THRIVE is unique among the frameworks because it both captures the core set of factors that shape health consistent with the others, and, serves as a tool with supporting resources, to move communities from understanding to assessment to action.

PI’s approach to health equity emphasizes understanding how structural drivers play out at the community level, with a focus on actionable strategies that improve health and safety and promote equity. For example, among its 12 community health factors, their THRIVE tool recognizes “What’s Sold and How It’s Promoted,” which allows communities to prioritize access to healthy, affordable food or focus on reducing alcohol density, both of which are associated with improved health outcomes. “The Social Networks & Trust” factor asks, Do people in my community know, trust and support each other? And, “The Parks & Open Space” factor asks, Are there safe places where people can enjoy nature and be active in my community? THRIVE’s supporting resources detail examples and provide sample strategies that improve community conditions for health.

THRIVE itself continues to be used by public health institutes and their state and local partners— including community health workers, community development corporations, community organizers, health clinics, hospitals and others— to develop community-informed, measureable, and actionable strategies on SDOH. PI’s updated THRIVE continues to help move communities from understanding determinants of health, to actions that create healthier, more equitable communities, their new paper finds.

The number and diversity of communities using THRIVE as a framework and tool continues to grow. Read the Prevention Institute paper to learn more about how communities can use THRIVE to address health equity through changes in the community environment.