The existential dimension of spirituality has proven to be of great importance over the last two decades when it comes to studies of self-rated health and quality of life. We see the positive effects it has on blood pressure, depression and life expectancy for chemotherapy and HIV patients, to mention just a few examples. In the public health sector, it is interesting to note that this existential/spiritual dimension had already been present in the early years when the term public health first came into the Swedish language. In the year 1926 public health was defined as ‘a people’s physical and spiritual health’. During the intervening years of major medical and scientific technical improvements in the field, the existential/spiritual perspective had been put aside, but now once again this dimension has come into focus. The central question is, how does the existential dimension of health, understood as a person’s ability to create and maintain functional meaning making systems, affect the person’s self-rated health and quality of life? The working theories and basic perspectives in this article are drawn from health research with attention to the existential dimension, public health from the perspective of the psychology of religion, and object relations theory.

The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches. Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.

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