in this framework the determinants are divided into upstream macrolevel factors midstream midlevel factors and downstream microlevel factors however mortality is the result of past experiences of risk factors while morbidity is the result of ongoing influences as important as mortality and morbidity are for all those affected to restrict actions to downstream factors does not address the socioeconomically driven determinants of health that are found more upstream here governmental policy plays a key role and is in turn influenced by still more upstream determinants of global forces