ANNEX 1 - The Modified DPSEEA Model
A simple model is promoted as a basis for building a strategy to inform policy and action in many complex situations. We believe an effective model must frame relationships in the field
of environment and human health with reference to the factors which bear upon them (often the influence of such factors is such that they might more accurately be assigned the status of co-determinants). It must also reference higher level drivers which shape the characteristics of environmental state. It has become clear that a model with the simplicity and flexibility to allow a rapid overview of key issues in health where environment is a factor must underpin Good Places, Better Health.
The development of the Modified DPSEEA Model 4 has been driven by the desire to achieve simplicity, flexibility in application and a capacity to map the environmental territory for different issues. The Modified DPSEEA model, is the adaptation of an earlier ( DPSEEA) model developed by WHO for developing indicators in the field of environment and human health. 5
In its unmodified form the DPSEEA model allows for the mapping of a spectrum of environmental health issues. The Model adopts a linear or 'chain' approach to mapping environment and health issues from high-level cultural, political Drivers of environmental change to Pressures which modify the physical environmental to produce an environment with defined characteristics (State). A particular environmental State in turn is mapped to human Exposure and on to health Effect. Critically, from a policy perspective, the DPSEEA Model also allows Actions to be mapped. These may impact at any point on the DPSEEA chain.
The Modified DPSEEA model recognises that whether a particular aspect of the environment (a State) results in an Exposure for the individual and whether that exposure results in a health Effect (positive or negative) is influenced by Context. That context may be demographic, social, behavioural, cultural, genetic etc. and aspects of Context may also be targets for policy and action to improve the health outcome.
Table 1: Elements of the Modified DPSEEA Model
Society level: social, economic or political influences on the environment
Factors resulting from drivers which act to modify or change the environmental state
The resultant environment which has been modified due to the pressure
Human interaction with modified environment
Human health effect
Policy and practice designed to address particular factors identified in the chain
Individual level: Social, economic, demographic factors which influence a person's exposure to the modified environment or which lead to a health effect
In communicating and applying the new approach, the Modified DPSEEA model retains the critical axis of health and physical environment at its core. In keeping with the philosophy of Good Places, Better Health it also affords cross-cutting policy relevance by recognising a spectrum of contextual issues which affect the transition from these environmental states to exposure and on to health outcomes (positive or negative).
Application of the model to selected health and physical environment axes produces a series of maps representing the relationship between the chosen health outcomes, the physical environment and other factors bearing upon that relationship, thus providing the desired helicopter view of the environmental health territory necessary for smart cross-cutting policy formulation.