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Table 4 Coding examples of education-related interventions

From: Systems change for the social determinants of health

Intervention level framework Meadows’ 12 leverage points Example recommendation Source
Paradigms The power to transcend paradigms None  
The mindset or paradigm out of which the system — its goals, structure, rules, delays, parameters — arises Provide good quality early years education and childcare proportionately across the gradient. This provision should be: Marmot Review
Goals The goals of the system An integrated policy for the provision of affordable, high quality day care and pre-school education with extra resources for disadvantaged communities. Acheson Report
The power to add, change, evolve, or self-organize system structure None  
The rules of the system (such as incentives, punishments, constraints) A statutory obligation should be placed on local authorities to ensure adequate day-care in their area for children under 5 and a minimum number of places the number being raised after regular intervals should be laid down centrally. Black Report
System Structure The structure of information flows (who does and does not have access to information) Ensure concerted efforts are made to reduce inequities in the local determinants of health through co-creation and partnership with those affected, civil society and a range of civic partners. WHO Review
Feedbacks and Delays The gain around driving positive feedback loops Further development of high quality pre-school education so that it meets, in particular, the needs of disadvantaged families. We also recommend that the benefits of pre-school education to disadvantaged families are evaluated and, if necessary, additional resources are made available to support further development. Acheson Report
The strength of negative feedback loops, relative to the impacts they are trying to correct against Increase the availability of non- vocational life-long learning across the life course Marmot Review
The lengths of delays, relative to the rate of system change Ensure actions are large enough in scale, of sufficient intensity and long enough in duration in order to have impact on levels of health inequalities. EU Marmot
Structural Elements The structure of material stocks and flows (such as transport networks, population age structures) Further develop 'health promoting schools', initially focused on, but not limited to, disadvantaged communities. Acheson Report
Enact policies which promote moderate intensity exercise including: further provision of cycling and walking routes to school, and other environmental modifications aimed at the safe separation of pedestrians and cyclists from motor vehicles; and safer opportunities for leisure. Acheson Report
The sizes of buffers and other stabilizing stocks, relative to their flows Provide good quality early years education and childcare proportionately across the gradient. This provision should be combined with outreach to increase the take-up by children from disadvantaged families Marmot Review
Constants, parameters, numbers (such as subsidies, taxes, standards) Provision of additional resources for schools serving children from less well off groups to enhance their educational achievement. The Revenue Support Grant formula and other funding mechanisms should be more strongly weighted to reflect need and socioeconomic disadvantage. Acheson Report
Not systems interventions Further measures to improve the nutrition provided at school, including: the promotion of school food policies; the development of budgeting and cooking skills; the preservation of free school meals entitlement; the provision of free school fruit; and the restriction of less healthy food. Acheson Report
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