Developing a critical realist informed framework to explain how the human rights and social determinants of health relationship works

Background: That there is a relationship between human rights and health is well established and frequently discussed. However, actions intended to take account of the relationship between human rights and social determinants of health have often been limited by lack of clarity and ambiguity concerning how these rights and determinants may interact and affect each other. It is difficult to know what to do when you do not understand how things work. As our own understanding of this consideration is founded on perspectives provided by the critical realist paradigm, we present an account of and commentary on our application of these perspectives in an investigation of this relationship. Findings: We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship. Those implications include the need to theorise possible entities involved in the relationship together with their distinctive properties and consequential power to affect one another through exercise of their respective mechanisms (ways of working). This theorising work enabled us identify a complex, multi-layered assembly of entities involved in the relationship and some of the array of causal mechanisms that may be in play. These are presented in a summary framework. Conclusion: Researchers' views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. We demonstrate that by attending to these views, which are founded in their paradigm positioning, researchers can make more progress in understanding the relationship between human rights and the social determinants of health, in particular when engaged in theorizing work. The same approaches could be drawn on when other significant relationships in health environments are investigated.