In 2013, VicHealth developed Fair Foundations as a conceptual model for the social determinants of health equity. In 2014, I was engaged to support the translation and application of the framework. Exploring: What would it look like to design initiatives that actively increase health equity across all levels of the framework? How might communities use Fair Foundations to address entrenched health inequities?

This work required a systems lens, not just thinking upstream, but also examining and shifting the underlying conditions that shape people’s lives. It led to the development of multiple approaches to support understanding and use of the framework, including:

• Cross-organisational influence to embed an equity lens across strategy and practice.

• Design and delivery of the Health Equity Leaders Program, equipping champions to lead equity-focused change within VicHealth.

• Collaboration with leading academics to produce a suite of evidence reviews on what works to reduce health inequities.

• Capability building across the community health sector to strengthen system-wide understanding of the social determinants of health equity.

• Development of VicHealth’s Health Equity Strategy, strengthening connections with the social and public policy sectors.

• Demonstration projects, including the Latrobe Valley Community Challenge, to explore how change can be influenced at the structural level - the socio-economic, political, and cultural context.

Based on the World Health Organisation’s Commission on Social Determinants of Health, Fair Foundations has been pivotal in shaping how I see the world. It reaffirmed for me that systems change must go beyond upstream thinking, it must question how social position is created and maintained, and focus on shifting those deeper patterns.

This work cemented my lifelong commitment to health equity and to supporting others to hold that lens with depth, courage, and clarity.