Analysis of Casual Relationships between Social Determinants of Health in Iran; Using fuzzy cognitive map

Nafiseh Salehnia, Abbas Assari Arani, Alireza Olyaeemanesh, Hossein Sadeghi Saghdel


Background: One of the most fundamental issues in recent years has been maintaining and promoting the society health, as making coordination in the policies of all sectors with the aim of health improvement has always been highly emphasized. The study aims to identify the socio-economic factors affecting health and to provide a cognitive map of the social determinants of health in Iran.

Study design: A retrospective cohort study

Methods: This study follows a developmental process with an exploratory sequential mixed methods approach. First, a meta-synthesis qualitative method determines the most critical health determinants by reviewing 54 studies within the period 2000-2019. Then, the fuzzy analysis draws the Fuzzy Cognitive Map (FCM) representing the causal relationships among the social determinants of population health in Iran.

Results: The first stage introduces 170 factors as the health determinants, classified into 4 levels: individual, local, national, and global levels with 7, 4, 13, and 3 branches, respectively. According to the causal relationships and the outdegree, the most effective factors are the economic system (18.24), governance and policy-making (17.13), and national policies (16.93). According to the degree of centrality, these factors are the economic system (33.27), health system (30.37), and governance and policy making (30.15).

Conclusion: Analyzing the causal relationships and FCM of public health determinants help the policy-makers to understand the priorities and the link among the sectors in develop and implement the health-oriented policies in all the sectors.


Health determinants, Public health, Fuzzy cognitive map, Health policy

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