The model was presented within a strategic framework for tackling health inequalities

(which has recently been updated for WHO – Dahlgren and Whitehead 2007), based on

the dual behavioural approach of improving health opportunities while tackling health

hazards. While the model does not demonstrate how the influencing factors in the tiers

combine to determine health outcomes in the way that NOA shows the way factors

influence behaviour, its nested basis is clear. The accompanying framework describes

reinforcing feedback loops at work between the tiers, in the context of diverse areas of

health inequality (eg. in the role of poverty, or in the uptake of smoking). The framework

also sketches out the elements of policy interventions to tackle health inequalities (eg. in

drinking behaviours, or obesity). In each case, the authors apply the Main Determinants of

Health model, demonstrating that interventions must simultaneously address factors within

each of the tiers if lasting change is to be brought about at the individual level.