Health Inequalities
"The term health inequality generically refers to differences in the health of individuals or groups (Kawachi et al, 2002). Any measurable aspect of health that varies across individuals or according to socially relevant groupings can be called a health inequality. Absent from the definition of health inequality is any moral judgment on whether observed differences are fair or just.
In contrast, a health inequity, or health disparity, is a specific type of health inequality that denotes an unjust difference in health. By one common definition, when health differences are preventable and unnecessary, allowing them to persist is unjust (Whitehead, 1991). In this sense, health inequities are systematic differences in health that could be avoided by reasonable means (Marmot et al, 2012)."
Arcaya, M. C., Arcaya, A. L., & Subramanian, S. V. (2015). Inequalities in health: definitions, concepts, and theories. Global Health Action, 8(1), 27106. https://dx.doi.org/10.3402%2Fgha.v8.27106
This page is designed as a reading list/resource to help reflect on health inequalities within the context of designing health promotion interventions. If you know of any more papers or links that would add value to this page, please let me know @benjanefitness (X) or @benjane.bsky.social
Recent Papers
Bambra, C. (2024). The U-shaped curve of health inequalities over the 20th and 21st centuries. International Journal of Social Determinants of Health and Health Services https://doi.org/10.1177/27551938241244695
The Kings Fund (Sept, 2024) Tackling health inequalities: seven priorities for the NHS. https://www.kingsfund.org.uk/insight-and-analysis/long-reads/tackling-health-inequalities-seven-priorities-nhs
What are Health Inequalities?
Albert-Ballestar, S., García-Altés, A. Measuring health inequalities: a systematic review of widely used indicators and topics. Int J Equity Health 20, 73 (2021). https://doi.org/10.1186/s12939-021-01397-3
Arcaya, M. C., Arcaya, A. L., & Subramanian, S. V. (2015). Inequalities in health: definitions, concepts, and theories. Global Health Action, 8(1), 27106. https://dx.doi.org/10.3402%2Fgha.v8.27106
Braveman, P. (2014). What is health equity: and how does a life-course approach take us further toward it?. Maternal and child health journal, 18(2), 366-372.
HealthKnowledge.org. (n.d.) Inequalities in health https://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/inequalities-distribution
Health Scotland (n.d.) What are health inequalities? http://www.healthscotland.scot/health-inequalities/what-are-health-inequalities
Kawachi, I., Subramanian, S. V., & Almeida-Filho, N. (2002). A glossary for health inequalities. Journal of Epidemiology & Community Health, 56(9), 647-652. http://dx.doi.org/10.1136/jech.56.9.647
The King's Fund (2021) Health inequalities in a nutshell https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-inequalities
The King's Fund (2020) What are Health Inequalities? https://www.kingsfund.org.uk/publications/what-are-health-inequalities
McCartney, G., Popham, F., McMaster, R., & Cumbers, A. (2019). Defining health and health inequalities. Public Health, 172, 22-30. https://doi.org/10.1016/j.puhe.2019.03.023
Public Health England (2017) Understanding health inequalities in England https://publichealthmatters.blog.gov.uk/2017/07/13/understanding-health-inequalities-in-england/
Whitehead, M. (1991). The concepts and principles of equity and health. Health Promotion International, 6(3), 217-228. https://doi.org/10.1093/heapro/6.3.217
Williams, Buck, Babalola (2020) What are health inequalities? https://www.kingsfund.org.uk/publications/what-are-health-inequalities#pathways
By Sir Michael Marmot
Marmot, M., Allen, J., Bell, R., Bloomer, E., & Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. The Lancet, 380(9846), 1011-1029. https://doi.org/10.1016/S0140-6736(12)61228-8
Marmot, M. (2017). Social justice, epidemiology and health inequalities. European Journal of Epidemiology, 32(7), 537-546. https://doi.org/10.1007/s10654-017-0286-3
Marmot, M. (2015). The health gap: the challenge of an unequal world. The Lancet, 386(10011), 2442-2444. https://doi.org/10.1016/S0140-6736(15)00150-6
Background reading on Amartya Sen and Martha Nussbaum's theories of capabilities
Tengland, P. A. (2020). Health and capabilities: a conceptual clarification. Medicine, Health Care and Philosophy, 23(1), 25-33. https://doi.org/10.1007/s11019-019-09902-w
On Social Determinants more broadly
Sallis, J. F., Owen, N. (2015) Ecological models of health behavior. In Glanz et al. Health behavior: theory, research, and practice. (5th ed.) Jossey-Bass, 43-64. (e-book)
Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: coming of age. Annual Review of Public Health, 32, 381-398. https://doi.org/10.1146/annurev-publhealth-031210-101218
Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(1_suppl), S28-S40. https://doi.org/10.1177/0022146510383498
Golden, S. D., & Earp, J. A. L. (2012). Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health education & behavior, 39(3), 364-372. https://doi.org/10.1177/1090198111418634
On what works (and doesn't)
Thomson, K., Hillier-Brown, F., Todd, A., McNamara, C., Huijts, T., & Bambra, C. (2018). The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health, 18(1), 869. https://doi.org/10.1186/s12889-018-5677-1
Baum, F., & Fisher, M. (2014). Why behavioural health promotion endures despite its failure to reduce health inequities. Sociology of health & illness, 36(2), 213-225. https://doi.org/10.1111/1467-9566.12112
Donkin A, Goldblatt P, Allen J, et al (2018) Global action on the social determinants of health BMJ Global Health 3:e000603. https://gh.bmj.com/content/3/Suppl_1/e000603
Dorling, D. (2013). Think Piece. In Place of Fear: Narrowing health inequalities http://classonline.org.uk/docs/2013_05_Think_piece_-_In_Place_of_Fear_(Danny_Dorling).pdf
Frohlich, K. L., & Potvin, L. (2008). Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. American journal of public health, 98(2), 216-221. https://doi.org/10.2105/AJPH.2007.114777
Kriznik, N. M., Kinmonth, A. L., Ling, T., & Kelly, M. P. (2018). Moving beyond individual choice in policies to reduce health inequalities: the integration of dynamic with individual explanations. Journal of Public Health, 40(4), 764-775. https://doi.org/10.1093/pubmed/fdy045
On the framing of Inequality and how this can be problematic
Lynch, J. (2017). Reframing inequality? The health inequalities turn as a dangerous frame shift. Journal of Public Health, 39(4), 653-660. https://doi.org/10.1093/pubmed/fdw140
On what Health Promoters can do on the ground
Pedersen, P. V., Hjelmar, U., Høybye, M. T., & Rod, M. H. (2017). Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities. Social science & medicine, 185, 1-8. https://doi.org/10.1016/j.socscimed.2017.05.025
On perpetuating Health Inequalities through Health Promotion
Lorenc, T., Petticrew, M., Welch, V., & Tugwell, P. (2013). What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health, 67(2), 190-193. http://dx.doi.org/10.1136/jech-2012-201257
White M, Adams J, Heywood P. (2009) How and why do interventions that increase health overall widen inequalities within populations? In Social inequality and public health. Edited by Babones SJ. Bristol: Policy Press 64–81.
Wiltshire, G., Lee, J., & Williams, O. (2019). Understanding the reproduction of health inequalities: Physical activity, social class and Bourdieu’s habitus. Sport, Education and Society, 24(3), 226-240. https://doi.org/10.1080/13573322.2017.1367657
Social/Health Inequalities and Research
Kelly-Irving, M., Ball, W. P., Bambra, C., Delpierre, C., Dundas, R., Lynch, J., ... & Smith, K. (2022). Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research. Critical Public Health, 1-11. https://doi.org/10.1080/09581596.2022.2036701
Powell, K. (2021) Powering health promotion – how can sociologists support political action on health inequalities? [blog] https://appsoc.org.uk/?p=1933
Straker, L., Holtermann, A., Lee, I. et al (2021) Privileging the privileged: the public health focus on leisure time physical activity has contributed to widening socioeconomic inequalities in health. British Journal of Sports Medicine 55:525-526. http://dx.doi.org/10.1136/bjsports-2020-103356
Helpful PHE Resources
PHE Wider Determinants Tool https://fingertips.phe.org.uk/profile/wider-determinants
Closing the health gap and reducing inequalities https://publichealthmatters.blog.gov.uk/2017/09/08/closing-the-health-gap-and-reducing-inequalities/
Health Profile for England https://www.gov.uk/government/publications/health-profile-for-england-2019
Public Health Matters Blog (Health Inequalities tag) - https://publichealthmatters.blog.gov.uk/category/priority2/health-inequalities-priority2/
Health Equity Assessment Tool (HEAT) (2020)-
Main page - https://www.gov.uk/government/publications/health-equity-assessment-tool-heat
e-learning - https://www.e-lfh.org.uk/programmes/health-equity-assessment-tool-heat/
Case Study of HEAT tool in action (Weight management) - https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/920031/Weight_Loss_Management_Services_HEAT_case_study.pdf
Baker, A., Bentley, C., Carr, D., Connolly, A. M., Heasman, M., & Johnson, C. (2017). Reducing health inequalities: system, scale and sustainability. London: Public Health England. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/731682/Reducing_health_inequalities_system_scale_and_sustainability.pdf
PHE (2014-2020) Local action on health inequalities: evidence papers https://www.gov.uk/government/publications/local-action-on-health-inequalities-evidence-papers
Health Inequalities and COVID-19
Bambra, C., Riordan, R., Ford, J., & Matthews, F. (2020). The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. http://dx.doi.org/10.1136/jech-2020-214401
Kawachi, I. (2020) COVID-19 and the ‘rediscovery’ of health inequities, International Journal of Epidemiology, , dyaa159, https://doi.org/10.1093/ije/dyaa159
Bambra, C., Norman, P., & Johnson, N. P. A. S. (2020). Visualising regional inequalities in the 1918 Spanish flu pandemic in England and Wales. Environment and Planning A: Economy and Space https://doi.org/10.1177%2F0308518X20969420
Todd, A., & Bambra, C. (2021). Learning from past mistakes? The COVID-19 vaccine and the inverse equity hypothesis. https://doi.org/10.1093/eurpub/ckaa243
Bambra, C., Lynch, J. and Smith, K.E. (2021) The Unequal Pandemic: COVID-19 and Health Inequalities https://policy.bristoluniversitypress.co.uk/the-unequal-pandemic
Health Inequalities and Physical Activity
Kay, T. (2017). Bodies of knowledge: connecting the evidence bases on physical activity and health inequalities. In Sport, Physical Activity and Public Health (pp. 7-26). Routledge.
Rigby, B. P., Dodd-Reynolds, C. J., & Oliver, E. J. (2020). Inequities and inequalities in outdoor walking groups: a scoping review. Public health reviews, 41(1), 1-24. https://doi.org/10.1186/s40985-020-00119-4
Williams, O., & Gibson, K. (2018). Exercise as a poisoned elixir: inactivity, inequality and intervention. Qualitative research in sport, exercise and health, 10(4), 412-428. https://doi.org/10.1080/2159676X.2017.1346698
Williams, T. L., Hunt, E. R., Papathomas, A., & Smith, B. (2018). Exercise is medicine? Most of the time for most; but not always for all. Qualitative Research in Sport, Exercise and Health, 10(4), 441-456. https://doi.org/10.1080/2159676X.2017.1405363
Recommended Books
Schrecker, T., & Bambra, C. (2015). How politics makes us sick: Neoliberal epidemics. Springer.
Bartley, M. (2016). Health inequality: an introduction to concepts, theories and methods. John Wiley & Sons.
Marmot, M. (2015). The health gap: the challenge of an unequal world. Bloomsbury Publishing.
Wilkinson, R., & Pickett, K. (2010). The spirit level: why equality is better for everyone. Penguin UK.
Wilkinson, R., & Pickett, K. (2018). The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing Allen Lane
Credit:
Thanks to @jana_semrau for the Frohlich and Lorenc suggestions.
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