The Cliff Analagy of Social Health

Camara Phyllis Jones

Addressing the Social determinants of  children’s Health: A Cliff Analogy

Journal of Health Care for the Poor and Underserved  20 (2009): 1–12.

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Abstract:

This  paper  presents  a  “Cliff  Analogy”  illustrating  three  dimensions  of  health intervention to help people who are falling off of the cliff of good health: providing health services, addressing the social determinants of health, and addressing the social determinants of equity. In the terms of the analogy, health services include an ambulance at the bottom of the cliff, a net or trampoline halfway down, and a fence at the top of the cliff. Addressing the social determinants of health involves the deliberate movement of the population away from the edge of the cliff. Addressing the social determinants of equity acknowledges that the cliff is three-dimensional and involves interventions on the structures, policies, practices,

norms, and values that differentially distribute resources and risks along the cliff face. The authors  affirm  that  we  need  to  address  both  the  social  determinants  of  health,  including poverty, and the social determinants ofequity, including racism, if we are to improve health outcomes and eliminate health disparities.