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Table 1 Intervention level framework

From: Systems change for the social determinants of health

Level Description Effectiveness
Paradigm System’s deepest held beliefs Difficult to intervene at this level but highly effective
Source of system’s goals, rules and structures
Goals 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