Hodges' Model: The Sustainable Development Goals and Public Health - Universal Health Coverage Demands a Universal Framework

"Future sustainable healthcare delivery and systems need reflective practitioners and critical thinkers to engage the public to achieve health policy aims and objectives."

Developed in the United Kingdom (UK) during the early 1980s, Hodges' model (h2cm) is a conceptual framework that is designed to facilitate integrated care, person centredness, and reflective practice and to help bridge the theory–practice gap. The building blocks are health and care concepts that arise clinically in practice. This paper applies H2cm to nutrition, specifically, in exploring how this pragmatic solution focused on the one-to-one relationship of learner–mentor, patient–clinician, public health professional–public, and groups can be applied to the Sustainable Development Goals (SDGs).

The h2cm method is a constructivist, practical, and educational exercise; the intended group can be defined/viewed as student, teacher, patient, carer, or member of the public in a health promotion campaign, for example. As shown in the figure below (and as detailed at Related Summaries, below), the model's two axes intersect. The horizontal axis differentiates between HUMANISTIC-MECHANISTIC activities and phenomena. The vertical axis is the INDIVIDUAL–GROUP (population).

The intersection of the axes creates four quadrants, domains within which the user of the model can place keywords as per a situation or context. These domains of care, or contextual, situated knowledge, are not placed arbitrarily, but they can be confirmed through a series of questions (a Socratic dialogue) drawing out the subjects (persons) and agents (formal and informal) and types of activities and interventions that fall under the auspices of health and care. Accordingly, the placement of concepts depends on the specific purpose and situation of the person(s) using the model. This situatedness accounts for the model's simplistic, complex ("rich"), and dialectical potential.

If the figure above is a blank template (an empty set), then - in the context of nutrition - one can develop the list of domains as follows:

• Sciences: Nutritional data/labelling on foodstuffs
• Intrapersonal-Interpersonal: Anxiety provoked by thoughts of body image and eating
• Sociology: Social behaviours and learning based in school regarding nutrition
• Political: Policies on advertising of high-calorie foods

In this review, the authors use the SDGs as input, deciding where in the aforementioned model the primary concepts in the SDG should be placed. They take each SDG (numbered 1-17, from "No poverty" through to "Partnership for the Goals") and assign it to a domain of Hodges' model. The outputs are presented as figures (two-by-two tables). Type 2 diabetes is an example, whereby application to H2cm highlights that attention needs to be paid to the person's level of (health) literacy, the balance of the individual's existing diet, shopping and factors such as income, health and technology (device) literacy, reading, food labelling, mobility, transport, and accessibility. (Ultimately, "The best way to 'Leave No One Behind' is to ensure individuals have the requisite literacies, so they can advocate for self, family and community...) The results of applying h2cm to this and other cases are not "data bound" but, rather, are found in reflection, critique, and discussion associated with the figures.

In conclusion: "As the SDGs are tracked and measures of progress refined,...Hodges' model can help academics, practitioners to navigate the inevitable complexity encountered to help assure public (mental) health at individual, community and global levels and act as a 'uniqueness preserver'... in delivering person-centred care. A generic, universal assessment and evaluation tool with sufficient conceptual scope and relevance can assist the implementation of the SDGs, achievement of sustainable healthcare systems and universal health coverage: a blueprint-realised."