Making the complexity of health easier to understand

Poor health, social and economic inequality and inequalities in health are challenging problems that are embedded into the fabric of society. The casual pathways in this guide simplify the complex interactions in order to present information in a user-friendly way.

They do so by using the DPSEEA framework (Corvalán, Briggs, & Kjellström, 1996): DPSEEA stands for Driving Force-Pressure-State-Exposure-Effect-Action (see DPSEEA terms for explanations of each term).

This framework has several advantages, as it:

  • Provides a holistic view of factors affecting health. EU Structural Funds are a significant source of investment for Member States and regions which, when carefully targeted, can influence the determinants of health.
  • Recognizes the importance of exposure in determining the final health effect: for example, poor air quality is bad for health. If you are not exposed to poor air quality you will not suffer any effects. This is an important consideration when analysing social exclusion: often, vulnerable and marginalised groups in society are exposed to a greater number of damaging factors.
  • Maintains a clear focus on action: policy-makers and analysts can use this approach to consider ways of addressing each node of the pathway. 
  • Provides a link to potential health indicators.


However, there are limitations for the DPSEEA framework.

It was developed to link environmental policy and health. Structural Funds need to use a wider perspective to bring in societal and economic issues. For this guide, DPSEEA has been usefully adapted to include the broader context (Morris, 2010;Stone & Morris, 2010), and the pages on funding themes use this method.

The DPSEEA framework tends to assume a linear flow from the environmental (and social and economic) context to health. However, the path might be reversed: for example better employment can improve and protect health, while poor health can mean that it is harder for people to find gainful employment, a particular problem for groups that experience social exclusion.

The sources on this page can be found in References