Concepts
Whitehead defined health inequity as differences in health that are unnecessary, avoidable and unfair. Marmot stressed the social gradient: health worsens at every step down the social ladder, not only at the bottom.
Four explanations in the Black Report
- Artefact: a product of measurement.
- Natural or social selection: poor health causes downward mobility.
- Cultural/behavioural: differences in smoking, diet and similar habits.
- Materialist/structural: income, housing and working conditions, which the report emphasised most.
Dahlgren-Whitehead model
The "rainbow" places age, sex and constitution at the centre, surrounded by lifestyle factors, social and community networks, living and working conditions, and general socioeconomic, cultural and environmental conditions.
Diderichsen model
Social context and policy create social stratification, which leads to differential exposure, differential vulnerability and differential consequences of illness, each offering an entry point for policy.
WHO and policy
The WHO Commission (2008) recommended improving daily living conditions, tackling the inequitable distribution of power, money and resources, and measuring the problem. "Health in all policies" is a common response, and Korea's National Health Plan names health equity as an overarching goal.
References
- Department of Health and Social Security. (1980). Inequalities in Health: Report of a Research Working Group (The Black Report). DHSS.
- Dahlgren, G., & Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Institute for Futures Studies.
- Diderichsen, F., Evans, T., & Whitehead, M. (2001). The social basis of disparities in health. In T. Evans et al. (Eds.), Challenging Inequities in Health (pp. 12-23). Oxford University Press.
- Commission on Social Determinants of Health. (2008). Closing the Gap in a Generation. World Health Organization.
- Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104.