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Table 1 Intervention level framework

From: Systems change for the social determinants of health





System’s deepest held beliefs

Difficult to intervene at this level but highly effective

Source of system’s goals, rules and structures


Targets that conform to the system’s paradigm and need to be achieved for paradigm to shift

Action at this level can change the aim of the system

System structure

Interconnections between system elements and subsystems

Action at this level will shift the system structure by changing system linkages and dynamics

Feedback and delays

Allows the system to regulate itself by providing information about the outcome of different actions back to the source of the actions

Actions at this level can create new feedback or increase gain around existing loops

Structural elements

Changes to physical elements of the system, its actors or subsystems

Easiest level at which to intervene.

Many actions at the level are required to create system-wide change