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

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 Inequalities and Research

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)-

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.