It´s time to rewrite the model of Social Determinants of Health (SDH) and include the existential dimension.

Background: The famous SDH-model, with layers in a semicircle, was first painted in the sand by M.Dr. Haglund and published in Swedish 1983 with M.Dr. Svanström. The model has been translated and modified through the years with more or less the same determinants. The last decades the existential dimension of health, sometimes referred to as spiritual, has proven to be of importance for health and health related quality of life [HQOL]. It was recognised as an aspect of supportive environment 1991. WHO developed 2002 a trans-cultural survey WHOQOL-SRPB for measuring HQOL including Spirituality, Religion and Personal Beliefs (religious or secular). This existential SRPB dimension consisted of: Meaning & Purpose in Life; Experiences of Awe & Wonder; Spiritual Connection; Wholeness & Integration; Spiritual Strength; Inner Peace and Hope & Optimism and Faith. Purpose of study: 1)The overall purpose is to generate knowledge about the existential dimension of health (understood as SRPB-aspects) in relation to SDH and their impact on HQOL. 2)To develop existential health promotion in a secularized Swedish context. The aim of this presentation is to introduce a refined model of SDH with the existential dimension. Methods/Theory: Theories of public-health, psychology of religion and HCL is combined in a mixed-method design. with now: Now consisting of WHOQOL-SRPB (original and BREF) surveys N=303, interviews with 15 focus groups and promotion evaluations. Findings: The existential aspects were relevant for participants in the interviews, preliminary partial psychometrically evaluates found correlation to SDH. Conclusion: Sustainable health promotion needs to consider the refined SDH-model