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John DH, Andress L, Aytur S, Dodge T, Gustat J, Schuchardt-Vogt CE, Lee RE. Scoping Conceptions of Equity: Reviewing a Decade of Physical Activity Research. JOURNAL OF HEALTHY EATING AND ACTIVE LIVING 2023; 3:7-18. [PMID: 37794922 PMCID: PMC10546938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Lee and Cubbin's (2009) call for a "socially just" Ecological Model of Physical Activity (EMPA) prompted an inquiry into physical activity (PA), active living (AL) research that advances social justice framed as a set of equity-centered principles for research. In response to the call, we conducted a scoping review to explore how PAAL research has operationalized equity to advance a socially-just EMPA. We searched for original research, published between 2010 and 2020, using key terms for 'physical activity' and 'equity' that produced 5,152 non-duplicated records. Title-abstract screening for exclusion/inclusion criteria disqualified 4,392 records. A review protocol and coding guide was developed, piloted, and revised by team members. The remaining 760 abstracts were reviewed and consensus coded for PA Variable (dependent or independent) and Factor (individual outcome or contextual exposure), Equity (population demographic or social-environmental determinant), and Social Ecological Milieu (SEM) (PAAL-specific or SEM-general policy, system, or environment (PSE) operations. Of the 463 studies selected, PA codified as an individual outcome (67%) more often than as a contextual-exposure (33%) factor. Equity codified more frequently as a population demographic (69%) rather than as a social-environmental determinant (31%). The SEM codified as PAAL-specific (44%) or as SEM-general (56%) PSE factors. Based on multistep study abstract reviews, the selected studies more often missed the opportunity to center equity in PAAL research by examining social, environmental, political, and systemic factors as institutionalized inequities at the root of PAAL disparities. We will not achieve a socially-just EMPA without shared conceptualizations of equity followed by intentional action.
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Affiliation(s)
| | - Lauri Andress
- University of New Mexico, College of Population Health,
U.S.A.
| | - Semra Aytur
- University of New Hampshire, Department of Health Management & Policy,
U.S.A.
| | - Tina Dodge
- Oregon State University, College of Health,
U.S.A.
| | - Jeanette Gustat
- Tulane University, School of Public Health & Tropical Medicine,
U.S.A.
| | - Clare E. Schuchardt-Vogt
- Arizona State University, Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation,
U.S.A.
| | - Rebecca E. Lee
- Arizona State University, Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation,
U.S.A.
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Schrecker T. Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2023:27551938231161932. [PMID: 37032455 DOI: 10.1177/27551938231161932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
A dramatic increase in the volume of research literature referencing social determinants of health (SDH) since the report of the World Health Organization Commission on the topic in 2008 has not been matched by expansion of policies and interventions to reduce health inequalities by way of SDH. This article argues that familiar hierarchies of evidence that privilege clinical epidemiology as used in evidence-based medicine are inappropriate to address SDH. They misunderstand both the range of relevant evidence and the value-based nature of standards of proof. A richer conceptual armamentarium is available; it includes several applications of the concepts of epidemiological worlds and the lifecourse, which are explained in the article. A more appropriate evidentiary approach to SDH and health inequalities requires "downing the master's tools," to adapt Audre Lorde's phrase, and instead applying a multidisciplinary approach to assessing the evidence that adequately reflects the complexity of the relevant causal pathways. Doing so is made more difficult by the power structures that shape research priorities, yet it is essential.
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Affiliation(s)
- Ted Schrecker
- Emeritus Professor of Global Health Policy, Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
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Louvel S, Soulier A. Biological embedding vs. embodiment of social experiences: How these two concepts form distinct thought styles around the social production of health inequalities. Soc Sci Med 2022; 314:115470. [PMID: 36327636 DOI: 10.1016/j.socscimed.2022.115470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/10/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This article compares research on biological embedding and the embodiment of social experiences, two concepts proposed in the 1990s to introduce a new perspective on the social production of health inequalities. We draw on Ludwig Fleck's concept of 'thought style' (1935/2008) to question the possible emergence of a common research program around the processes by which the social becomes biological. METHODS We compiled a corpus of 322 articles referring to either biological embedding or to the embodiment of social experiences, identified in the Web of Science core collection and published from 1990 to 2021. We analyzed the articles' use of these concepts using scientometric indicators and qualitative content analysis. RESULTS Initial differences between the research agendas associated with biological embedding and embodiment are strengthened as both concepts circulate around scientific communities studying the social production of health inequalities. Thought styles formed around embedding and embodiment differ significantly in terms of shared references, sets of methods and research questions, and policy recommendations. Research on biological embedding forms a thought style shared by researchers in the biomedical and public health sciences. Conversely, the concept of embodiment of social experiences connects perspectives from biomedical, public health, human and social sciences, and gathers three thought styles, one identical to that of biological embedding and two formed in social epidemiology and in medical anthropology. CONCLUSIONS Acknowledging the differences between the concepts and divergences in their evolution provides an opportunity for identification of topics where thought styles are either complementary or in tension.
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Affiliation(s)
- Séverine Louvel
- PACTE - Sciences Po Grenoble, 1030 Avenue Centrale, Domaine Universitaire, 38040 Grenoble Cedex 09, France.
| | - Alexandra Soulier
- IHPST - Institut D'histoire et de Philosophie des Sciences et des Techniques (UMR 8590), Maison de La Philosophie - Marin Mersenne, 13, Rue Du Four, 75006 Paris, France.
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van Schalkwyk MCI, Zenone M, Maani N, Petticrew M, McKee M. Back to our roots or sowing new seeds: thinking anew on the paradigms of health, harm and disease. J Public Health (Oxf) 2022; 44:i28-i33. [PMID: 36465052 PMCID: PMC9720360 DOI: 10.1093/pubmed/fdac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Health, harms and disease are intimately linked, and their promotion and distribution are determined by the social, political and physical worlds in which people live. Yet, the popular narrative on health is still dominated by a biological model that focuses on a disease-causing 'pathogen' or 'agent' that leads to pathology which is diagnosable and amenable to intervention at the individual level via measures delivered through the health care and public health systems. This model generally rests on understanding populations as a collection of individuals, with the pattern of disease seen as the sum of a series of risk factors acting on each of them. Too little attention is paid to the ways in which health, harm, disease, causation and risk are conceptualized and used as guiding concepts in research, policy debates and other fora. We often overlook the distribution of health and the regulatory regimes, norms, values and rights that promote or undermine health. By challenging our ways of thinking about health, harms and disease, we can start to appreciate with greater depth the ways in which health can be threatened and what should be seen as harmful, and conversely, opportunities for moving our systems towards promoting and protecting health.
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Affiliation(s)
- May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Marco Zenone
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
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Kelly-Irving M, Ball WP, Bambra C, Delpierre C, Dundas R, Lynch J, McCartney G, Smith K. Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2036701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Michelle Kelly-Irving
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Institut fédératif de recherche et d’études interdisciplinaire santé société, Université de Toulouse, Toulouse, France
| | | | - Clare Bambra
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, UK
| | - Cyrille Delpierre
- Centre for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Julia Lynch
- Department of Political Science and Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, U S.A
| | - Gerry McCartney
- College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Katherine Smith
- School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
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Schrecker T. What is critical about critical public health? Focus on health inequalities. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1905776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ted Schrecker
- Global Health Policy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Wildgen A, Denny K. Health Equity’s Missing Substance: (Re)Engaging the Normative in Public Health Discourse and Knowledge Making. Public Health Ethics 2020. [DOI: 10.1093/phe/phaa019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Since 1984, the idea of health equity has proliferated throughout public health discourse with little mainstream critique for its variability and distance from its original articulation signifying social transformation and a commitment to social justice. In the years since health equity’s emergence and proliferation, it has taken on a seemingly endless range of invocations and deployments, but it most often translates into proactive and apolitical discourse and practice. In Margaret Whitehead’s influential characterization (1991), achieving health equity requires determining what is inequitable by examining and judging the causes of inequalities in the context of what is going on in the rest of society. However, it also remains unclear how or if public health actors examine and judge the causes of health inequality. In this article, we take the concept of health equity itself as an object of study and consider the ways in which its widespread deployment has entailed a considerable emptying of its semantic and political content. We point toward equity’s own discursive productivity as well as the quantifying imperative embedded within evidentiary norms that govern knowledge making, and performance management regimes that govern public health practices. Under current conditions of knowledge making and performance evaluation, a range of legitimate action and inaction is produced at the same time that more socially transformative action is legitimately curtailed—not merely by politics, but by the rules of the field in which public health actors work. Ultimately, meaningful progress on a normative ethical idea like health equity will require both substantial philosophical content and an analysis of what is going on in the rest of society.
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Eikemo TA, Øversveen E. Social Inequalities in health: Challenges, knowledge gaps, key debates and the need for new data. Scand J Public Health 2019; 47:593-597. [PMID: 31512565 DOI: 10.1177/1403494819866416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Terje A Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Emil Øversveen
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Jane B, Gibson K. Corporate sponsorship of physical activity promotion programmes: part of the solution or part of the problem? J Public Health (Oxf) 2019; 40:279-288. [PMID: 28591792 DOI: 10.1093/pubmed/fdx065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/18/2017] [Indexed: 11/12/2022] Open
Abstract
Background Parklives is a programme intended to raise levels of physical activity across the UK, funded by Coca-Cola GB and delivered in association with Local Authorities and other organizations. Such public-private partnerships have been advocated by many however critics suggest that the conflict between stakeholder motives is too great. Methods This study conducted a content analysis of twitter content related to the ParkLives physical activity programme. Images and text were analysed from two separate weeks, one from the school vacation period and one during school term time. Results Three hundred and eighteen tweets were analysed. Content analysis revealed 79% of images contained children and 45% of these images contained prominent Coca-Cola branding, a level of exposure that suggests ParkLives simultaneously provides opportunities for children's physical activity and for targeted marketing. Content analysis also demonstrated that the programme allowed increased access to policy-makers. Conclusions The sponsorship of a physical activity promotion campaign can allow a corporation to target its marketing at children and gain access to health-related policy development networks. This study reinforces the need for independent evaluation of all potential impacts of such a partnership and calls on those responsible for community health to fully consider the ethical implications of such relationships.
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Affiliation(s)
- B Jane
- Faculty of Sport and Health, The University of St Mark & St John, Derriford Rd, Derriford, Plymouth, UK
| | - K Gibson
- Faculty of Sport and Health, The University of St Mark & St John, Derriford Rd, Derriford, Plymouth, UK
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Plamondon KM, Bottorff JL, Caxaj CS, Graham ID. The integration of evidence from the Commission on Social Determinants of Health in the field of health equity: a scoping review. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1551613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Katrina M. Plamondon
- Interdisciplinary Graduate Studies, University of British Columbia, Kelowna, Canada
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - Joan L. Bottorff
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - C. Susana Caxaj
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
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Brisbois BW, Harris L, Spiegel JM. Political Ecologies of Global Health: Pesticide Exposure in Southwestern Ecuador's Banana Industry. ANTIPODE 2018; 50:61-81. [PMID: 29456272 PMCID: PMC5812055 DOI: 10.1111/anti.12340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 06/08/2023]
Abstract
Pesticide exposure in Ecuador's banana industry reflects political economic and ecological processes that interact across scales to affect human health. We use this case study to illustrate opportunities for applying political ecology of health scholarship in the burgeoning field of global health. Drawing on an historical literature review and ethnographic data collected in Ecuador's El Oro province, we present three main areas where a political ecological approach can enrich global health scholarship: perceptive characterization of multi-scalar and ecologically entangled pathways to health outcomes; critical analysis of discursive dynamics such as competing scalar narratives; and appreciation of the environment-linked subjectivities and emotions of people experiencing globalized health impacts. Rapprochement between these fields may also provide political ecologists with access to valuable empirical data on health outcomes, venues for engaged scholarship, and opportunities to synthesize numerous insightful case studies and discern broader patterns.
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Affiliation(s)
- Ben Wesley Brisbois
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | - Leila Harris
- Institute for Resources, Environment and SustainabilityUniversity of British ColumbiaVancouverBCCanada
- Stellenbosch Institute for Advanced StudiesUniversity of StellenboschSouth Africa
| | - Jerry M. Spiegel
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
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12
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Was Mackenbach right? Towards a practical political science of redistribution and health inequalities. Health Place 2017; 46:293-299. [PMID: 28689134 DOI: 10.1016/j.healthplace.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 05/27/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022]
Abstract
In 2010, Mackenbach reflected on England's lack of success in reducing health inequalities between 1997 and 2010, asserting that "it is difficult to imagine a longer window of opportunity for tackling health inequalities"; asking "[i]f this did not work, what will?"; and concluding that reducing health inequalities was not politically feasible at least in that jurisdiction. Exploring the empirics of that observation offers a window into the politics of reducing health inequalities. For purposes of future comparative research, I outline three (not mutually exclusive) perspectives on political feasibility, identify their implications for a political science of health inequalities, and explore what they mean for advocacy in support of reducing those inequalities.
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13
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Theorising participatory practice and alienation in health research: A materialist approach. SOCIAL THEORY & HEALTH 2015. [DOI: 10.1057/sth.2015.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Kapilashrami A, Smith KE, Fustukian S, Eltanani MK, Laughlin S, Robertson T, Muir J, Gallova E, Scandrett E. Social movements and public health advocacy in action: the UK people's health movement. J Public Health (Oxf) 2015; 38:413-416. [DOI: 10.1093/pubmed/fdv085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Spiegel JM, Breilh J, Yassi A. Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program. Global Health 2015; 11:9. [PMID: 25880442 PMCID: PMC4353467 DOI: 10.1186/s12992-015-0091-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/27/2015] [Indexed: 01/21/2023] Open
Abstract
Background Focus on “social determinants of health” provides a welcome alternative to the bio-medical illness paradigm. However, the tendency to concentrate on the influence of “risk factors” related to living and working conditions of individuals, rather than to more broadly examine dynamics of the social processes that affect population health, has triggered critical reaction not only from the Global North but especially from voices the Global South where there is a long history of addressing questions of health equity. In this article, we elaborate on how focusing instead on the language of “social determination of health” has prompted us to attempt to apply a more equity-sensitive approaches to research and related policy and praxis. Discussion In this debate, we briefly explore the epistemological and historical roots of epidemiological approaches to health and health equity that have emerged in Latin America to consider its relevance to global discourse. In this region marked by pronounced inequity, context-sensitive concepts such as “collective health” and “critical epidemiology” have been prominent, albeit with limited acknowledgement by the Global North. We illustrate our attempts to apply a social determination approach (and the “4 S” elements of bio-Security, Sovereignty, Solidarity and Sustainability) in five projects within our research collaboration linking researchers and knowledge users in Ecuador and Canada, in diverse settings (health of healthcare workers; food systems; antibiotic resistance; vector borne disease [dengue]; and social circus with street youth). Conclusions We argue that the language of social determinants lends itself to research that is more reductionist and beckons the development of different skills than would be applied when adopting the language of social determination. We conclude that this language leads to more direct analysis of the systemic factors that drive, promote and reinforce disparities, while at the same time directly considering the emancipatory forces capable of countering negative health impacts. It follows that “reverse innovation” must not only recognize practical solutions being developed in low and middle income countries, but must also build on the strengths of the theoretical-methodological reasoning that has emerged in the South.
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Affiliation(s)
- Jerry M Spiegel
- School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
| | - Jaime Breilh
- Health Sciences Area, University Andina Simon Bolivar, Quito, Ecuador.
| | - Annalee Yassi
- School of Population and Public Health, Department of Medicine, the University of British Columbia, Rm. 430 - 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.
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Abstract
There is a very large literature examining income inequality in relation to health. Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. More recent studies, not included in those reviews, provide substantial new evidence. Our purpose in this paper is to assess whether or not wider income differences play a causal role leading to worse health. We conducted a literature review within an epidemiological causal framework and inferred the likelihood of a causal relationship between income inequality and health (including violence) by considering the evidence as a whole. The body of evidence strongly suggests that income inequality affects population health and wellbeing. The major causal criteria of temporality, biological plausibility, consistency and lack of alternative explanations are well supported. Of the small minority of studies which find no association, most can be explained by income inequality being measured at an inappropriate scale, the inclusion of mediating variables as controls, the use of subjective rather than objective measures of health, or follow up periods which are too short. The evidence that large income differences have damaging health and social consequences is strong and in most countries inequality is increasing. Narrowing the gap will improve the health and wellbeing of populations.
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Affiliation(s)
- Kate E Pickett
- Department of Health Sciences, University of York, York, UK.
| | - Richard G Wilkinson
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Affiliation(s)
- Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec H3A 1A2 Canada.
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