Health in MWIA

The MWIA framework takes account of population characteristics (age, gender, race, class, disability, and sexuality) and the wider determinants of mental health (income, education, environment, employment), and uses a four factor framework (adapted from Department of Health 2001) as follows:

• Enhancing control e.g. opportunities for decision making, independence, autonomy, influence, self-help, job control, choice and levels of democracy
• Increasing resilience and community assets e.g. hopefulness, optimism, life satisfaction, trust & safety, social networks, social support, public spaces, accessible services
• Facilitating participation e.g. valued roles, sense of belonging, getting involved, decision-making, collective action, voting and other forms of civic engagement.
• Promoting inclusion e.g. positive identities, tolerance & cohesion, practical support, challenging discrimination, tackling inequalities.

These four factors – control, resilience, participation and inclusion are important pathways through which wider social determinants – for example financial security, housing, education, occupation – influence outcomes.

Each factor can be considered at three levels, although in practice there is often overlap between the levels:

• Individual
• Community / social
• Socio-economic / environmental.

There is growing evidence that mental well-being is a key pathway through which inequalities impact on health. “The importance of mental health and well-being is directly and indirectly related at every human level to human responses to inequalities.” Mental health, resilience and inequalities Friedli L. (2009) .