Jinks et al. BMC Public Health 2010, 10:148 http://www.biomedcentral.com/1471-2458/10/148 inequalities in health. The rainbow model developed by Dahlgren and Whitehead [3] has been most widely used. They argue that the health of individuals who are endowed with age, sex and genetic factors are influenced by a number of layers that they diagrammatically pre- sent in the form of a rainbow (Figure 1): first, personal behaviour and ways of life that can damage or enhance health. These are influenced by social and community networks, which in turn, are contextualised by living and working conditions and access to facilities (includ- ing health and social care). The broader economic, cul- tural and environmental conditions in a society have a bearing on all the other layers below. This model, along- side others such as the one formulated by Brunner and Marmot [4] who include early life and cultural factors into the pathways to health, are primarily geared to an analysis of macro social factors. Further models can be added to the above approaches. These include the theo- retical contribution of Bartley [5] who draws attention to further influences such as the physical environment of home, neighbourhood and workplace, and people’s standard of living; the work on cumulative disadvantage through the life course by Davey Smith and Kuh, [6] and how these may be exacerbated through living in particular places [7]. Page 2 of 9 The individual-oriented and the structural approach to health and illness are increasingly seen as to provide only partial answers to how to understand people’s health status, and a body of work has emerged in the last few years that offers a new theoretical direction. Frohlich et.al. [8] argue that the missing question cen- tres around understanding the relationship between agency (the ability for people to deploy a range of causal powers), practices (the activities that make and trans- form the world we live in) and social structure (the rules and resources in society). They critique the beha- viourist interpretation of lifestyles and instead propose to define them as patterns and ways of living or as beha- viours and their interactions with cultural, social and psycho-social factors. This leads them to conclude that it is important to recognise that the context (or struc- ture) acts on individuals, but in turn individuals are re- creating the conditions that make this context possible (agency). We have, therefore, sought to explore aspects of agency and structure alongside Dahlgren and White- head’s rainbow model in order to reveal a more nuanced understanding of the determinants of health in relation to knee pain and disability in older adults. Our study uses the model as a point of departure for a conversa- tion about people’s own health, their practices - in Figure 1 Picture aid used in qualitative interviews with people to discuss prevention of knee pain and disability.