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Conceptual Approaches to Examining Health Inequities

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Abstract

This chapter maps key conceptual frameworks in the study of health inequities. Using the dominant approach in the public health literature termed the risk factor approach as a reference point; the chapter highlights the key critiques of this approach. These key critiques include the differentiation between the causes of disease and the causes of causes, the demand to move from demonstrating associations to exploring and defining mechanisms and a critical interrogation of the labels being used. Through a mapping of various frameworks drawn from diverse fields, the chapter presents conceptual approaches which contribute to the filling of these critical gaps in the mainstream public health literature. The chapter ends by identifying the recently articulated frameworks like the ecosocial theory and the intersectionality lens as having attempted to engage with health inequities in a more nuanced fashion and with more depth, and as representing the best conceptual theories we have presently to research this area. We ask in the review and critique that forms the core chapters of the book, how this literature and these frameworks have informed the research being reviewed? We also ask how these insights can help make newer sense by reading across the research in an attempt to delineate what the present literature implies about possible mechanisms as well as gaps in research.

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Notes

  1. 1.

    We draw on Mel Bartley’s Book Health Inequality for descriptions of these five approaches.

References

  • Amrith, S. (2007). Political culture of health in India: A historical perspective. Economic and Political Weekly, 42, 114–121.

    Google Scholar 

  • Anne, M., Callahan, J., & Kang, H. (n.d.). Gender and caste intersectionality in the Indian context. Retrieved from http://www.ufhrd.co.uk/wordpress/wp-content/uploads/2013/09/Mrudula-Callahan-Kang-full-paper.pdf.

  • Balarajan, Y., Selvaraj, S., & Subramanian, S. V. (2011). Health care and equity in India. The Lancet, 377, 505–515. Retrieved from http://dx.doi.org/10.1016/S0140-6736(10)61894-6.

  • Bartley, M. (2004). Health inequality: An introduction to theories, concepts and methods (1st ed.). Cambridge: Polity Press.

    Google Scholar 

  • Baru, R. V. (2010). Health service inequities as challenge to health security. Oxfam India working papers series. Retrieved from https://www.oxfamindia.org/sites/default/files/IV.%20Health%20Service%20Inequities%20as%20Challenge%20to%20Health%20Security.pdf.

  • Beckfield, J., & Krieger, N. (2009). Epi + demos + cracy: Linking political systems and priorities to the magnitude of health inequities—Evidence, gaps, and a research agenda. Epidemiologic Reviews, 31, 152–177. doi:10.1093/epirev/mxp002.

    Article  PubMed  Google Scholar 

  • Beckfield, J., Bambra, C., Eikemo, T. A., Huijts, T., McNamara, C., & Wendt, C. (2015). An institutional theory of welfare state effects on the distribution of population health. Social Theory & Health, 13, 227–244. Retrieved from http://www.palgrave-journals.com/sth/journal/vaop/ncurrent/full/sth201519a.html; http://www.palgrave-journals.com/sth/journal/v13/n3-4/full/sth201519a.html.

  • Birn, A. E. (2009). Making it politic (al): Closing the gap in a generation: Health equity through action on the social determinants of health. Social Medicine, 4(3), 166–182.

    Google Scholar 

  • Black, D., Morris, J. N., & Townsend, P. (1982). Inequalities in health: The black report. In P. Townsend & N. Davidsn (Eds.), The black report and the health divide (pp. 39–233). Harmondsworth: Penguin.

    Google Scholar 

  • Blane, D. (1985). An assessment of the black report’s explanations of health inequalities. Sociology of Health & Illness, 7(3), 423–446.

    Article  Google Scholar 

  • Bosma, H., Van De Mheen, H. D., & Mackenbach, J. P. (1999). Social class in childhood and general health in adulthood:  Questionnaire study of contribution of psychological attributes. British Medical Journal, 318, 18–22.

    Google Scholar 

  • Braveman, P., & Gruskin, (2003). Defining equity in health. Journal of Epidemiology and Community Health, 57, 254–258.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Brunner, E. (1997). Socioeconomic determinants of health: Stress and the biology of inequality impact of early experience stressors in the hierarchy. British Medical Journal, 314(7092), 1472–1476.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bunge, M. (2004). How does it work? The search for explanatory mechanisms. Philosophy of the Social Sciences, 34(2), 182–210. Retrieved from http://pos.sagepub.com/cgi/doi/10.1177/0048393103262550.

  • Chakravarthi, U. (2006). Gendering caste: Through a feminist lens. Kolkata: Stree.

    Google Scholar 

  • Coburn, D. (2000). Income inequality, social cohesion and the health status of populations: The role of neo-liberalism. Social Science and Medicine, 51(1), 135–146.

    Article  CAS  PubMed  Google Scholar 

  • Cockerham, W. C. (2005). Health lifestyle theory and the convergence of agency and structure. Journal of Health and Social Behavior, 46, 51–67.

    Article  PubMed  Google Scholar 

  • Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241–1299.

    Article  Google Scholar 

  • Dhamoon, R. K. (2011). Considerations on mainstreaming intersectionality. Political Research Quarterly, 64(1), 230–243.

    Article  Google Scholar 

  • Diderichsen, F., Evans, T., & Whitehead, M. (2001). The social basis of disparities in health. In T. Evans, M. Whitehead, & F. Diderichsen (Eds.), Challenging inequities in health: From ethics to action. Oxford, New York: Oxford University Press.

    Google Scholar 

  • Doyal, L. (1979). The political economy of health. London: Pluto Press.

    Google Scholar 

  • Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Princeton, New Jersey: Princeton University Press. Retrieved from http://isites.harvard.edu/fs/docs/icb.topic1134169.files/Readings%20on%20Social%20Democracy/Esping%20Anderson%20%20THe%20Three%20Worlds%20of%20Welfare%20Capitalism.pdf.

  • Farmer, P. (2004). Pathologies of power: Health, human rights, and the new war on the poor. Berkeley and Los Angeles: University of California Press.

    Google Scholar 

  • Freese, J., & Lutfey, K. (2011). Fundamental causality: Challenges of an animating concept for medical sociology. In B. A. Pescosolido et al. (Eds.), Handbook of the sociology of health, illness, and healing: A blueprint for the 21st century (pp. 67–81). New York: Springer.

    Chapter  Google Scholar 

  • Guru, G. (2016). Shifting categories in the discourse on caste and class. Economic and Political Weekly, 51(47), 21–25.

    Google Scholar 

  • Hancock, A.-M. (2007). When multiplication doesn’t equal quick addition: Examining intersectionality as a research paradigm. Perspectives on Politics, 5(1), 63–79. Retrieved from http://www.journals.cambridge.org/abstract_S1537592707070065.

  • Hancock, A.-M. (2016). Intersectionality: An intellectual history. New York: Oxford University Press.

    Book  Google Scholar 

  • Hankivsky, O., & Christoffersen, A. (2008). Intersectionality and the determinants of health: A Canadian perspective. Critical Public Health, 18(3), 271–283. http://www.tandfonline.com/doi/abs/10.1080/09581590802294296.

  • Hankivsky, O., Grace, D., Hunting, G., & Ferlatte, O. (2012). Introduction: Why intersectionality matters for health equity and policy analysis. In O. Hankivsky (Ed.), An intersectionality based policy analysis framework (p. 18). Vancouver, BC: Institute for Intersectionality Research and Policy, Simon Fraser University.

    Google Scholar 

  • Horton, S., & Barker, J. C. (2010). Stigmatised biologies: Examining the cumulative effects of oral health disparities for Mexican American farm worker children. Medical Anthropology Quarterly, 24(2), 199–219.

    Article  PubMed  PubMed Central  Google Scholar 

  • Irwin, A., & Scali, E. (2005). Action on the social determinants of health: Learning from previous experiences. A background paper prepared for the commission on social determinants of health. Geneva: WHO, Secretariat of the Commission on Social Determinants of Health.

    Google Scholar 

  • Kapilashrami, A., Hill, S., & Meer, N. (2015). What can health inequalities researchers learn from an intersectionality perspective? Understanding social dynamics with an inter-categorical approach? Social Theory & Health, 13(3–4), 288–307. Retrieved from http://www.palgrave-journals.com/doifinder/10.1057/sth.2015.16.

  • Keshavjee, S. (2014). Blind spot: How neoliberalism infiltrated global health (1st ed.). Berkeley and Los Angeles: University of California Press.

    Google Scholar 

  • Kim, J. Y., Millen. J. V., Irwin, A., & Gershman, J. (2000). Dying for growth: Global inequality and the health of the poor (J. Y. Kim et al., Editors). Monroe, Maine: Common Courage Press.

    Google Scholar 

  • Krieger, N. (2011a). Social epidemiologic alternatives: Socio-political and psycholosocial frameworks. In N. Krieger (Ed.), Epidemiology and the people’s health: Theory and context (pp. 163–201). New York: Oxford University Press.

    Chapter  Google Scholar 

  • Krieger, N. (2011b). Ecosocial theory of disease distribution: Embodying societal and ecological context. In N. Krieger (Ed.), Epidemiology and the people’s health: Theory and context (p. 215). New York: Oxford University Press.

    Chapter  Google Scholar 

  • Krieger, N. (2012). Methods for the scientific study of discrimination and health: An ecosocial approach. American Journal of Public Health, 102(5), 936–945.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krieger, N., Alegrìa, M., Almeida-Filho, N., da Silva, J. B., Barreto, M. L., Beckfield, J., … Walters, K. L. (2010). Who, and what, causes health inequities? Reflections on emerging debates from an exploratory Latin American/North American workshop. Journal of Epidemiology and Community Health, 64(9), 747–749.

    Google Scholar 

  • Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in us public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378.

    Article  CAS  PubMed  Google Scholar 

  • Link, B. G., & Phelan, J. C. (1996). Understanding sociodemographic differences in health—The role of fundamental social causes. American Journal of Public Health, 86(4), 471–473.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.

    Article  CAS  PubMed  Google Scholar 

  • McNay, L. (1999). Gender, Habitus and the field: Pierre Bourdieu and the limits of reflexivity. Theory Culture Society, 16(1), 95–117.

    Article  Google Scholar 

  • Moller, S., Huber, E., Stephens, J. D., Bradley, D., & Nielsen, F. (2003). Determinants of relative poverty in advanced capitalist democracies. American Sociological Review, 68(1), 22–51.

    Article  Google Scholar 

  • Muntaner, C., Ng, E., Chung, H., & Prins, S. J. (2015). Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction. Social Theory & Health, 13(3–4), 267–287. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26345311.

  • Muntaner, C., Ng, E., Vanroelen, C., Christ, S., & Eaton, W. W. (2013). Social stratification, social closure and social class as determinants of mental health disparities. In C. S. Aneshensel, J. C. Phelan, & A. Bierman (Eds.), Handbook of the sociology of mental health (pp. 205–227). Dordrecht, Netherlands: Springer.

    Google Scholar 

  • Navarro, V. (2004). Introduction: Objectives and purposes of the study. In V. Navarro (Ed.), The political and social contexts of health (p. 8). Amityville, NY: Baywood Publishing Company.

    Google Scholar 

  • Navarro, V. (2009). What we mean by social determinants of health. Global Health Promotion, 16(1), 5–16.

    Article  PubMed  Google Scholar 

  • Navarro, V., & Muntaner, C. (2004). Political and economic determinants of population health and well being: Controversies and developments. Amityville, NY: Baywood Publishing Company.

    Google Scholar 

  • Obregón, D. (2008). We are under no illusions: Closing the gap in a generation, the report of the WHO Commission on Social Determinants of Health. Paper presented at The World Health Organization and the Social Determinants of Health: Assessing theory, policy and practice. London, UK: Wellcome Trust Centre for the History of Medicine at UCL. November 26–28, 2008.

    Google Scholar 

  • Phelan, J. C., & Link, B. G. (2013). Fundamental cause theory. In W. C. Cockerham (Ed.), Medical sociology on the move: New directions in theory (pp. 105–126, 1st ed.). Dordrecht: Springer.

    Google Scholar 

  • 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, S28–S40.

    Article  PubMed  Google Scholar 

  • Pickel, A. (2004). Systems and mechanisms a symposium on Mario Bunge’s philosophy of social science. Philosophy of the Social Sciences, 34(2), 169–181.

    Article  Google Scholar 

  • Purkayastha, B., Subramanian, M., Desai, M., & Bose, S. (2003). The study of gender in India: A partial review. Gender & Society, 17(4), 503–524. Retrieved from http://gas.sagepub.com/cgi/doi/10.1177/0891243203253793.

  • Rege, S. (2013). Against the madness of Manu: B R Ambedkars’s writings on brahmanical patriarchy. New Delhi: Navayana.

    Google Scholar 

  • Rose, G. (2001). Sick individuals and sick populations. International Journal of Epidemiology, 30(1), 427–432.

    Article  CAS  PubMed  Google Scholar 

  • Sanneving, L., Trygg, N., Saxena, D., Mavalankar, D., & Thomsen, S. (2013). Inequity in India: The case of maternal and reproductive health. Global Health Action, 6, 19145.

    Article  Google Scholar 

  • Scambler, G., & Scambler, S. (2015). Theorising health inequalities: The untapped potential of dialectical critical realism. Social Theory & Health, 13(3–4), 340–354. Retrieved from http://www.palgrave-journals.com/doifinder/10.1057/sth.2015.14.

  • Sen, A. (1999). Inequality re-examined (Seventh im.). New Delhi: Oxford University Press.

    Google Scholar 

  • Siegrist, J. (2000). Place, social exchange and health: Proposed sociological framework. Social Science and Medicine, 51, 1283–1293.

    Article  CAS  PubMed  Google Scholar 

  • Smith, K. E., & Schrecker, T. (2015). Theorising health inequalities: Introduction to a double special issue. Social Theory & Health, 13(3–4), 219–226.

    Article  Google Scholar 

  • Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. Social determinants of health discussion paper 2 (policy and practice) (p. 6). Geneva: World Health Organization.

    Google Scholar 

  • Whitehead, M. (2000). The concepts and principles of equity in health. Copenhagen: World Health Organisation, Regional Office for Europe. Retrieved from http://salud.ciee.flacso.org.ar/flacso/optativas/equity_and_health.pdf.

  • Williams, S. J. (1995). Theorising class, health and lifestyles: Can Bourdieu help us? Sociology of Health & Illness, 17(5), 577–604.

    Article  Google Scholar 

  • Winker, G., & Degele, N. (2011). Intersectionality as multi-level analysis: Dealing with social inequality. European Journal of Women’s Studies, 18(1), 51–66.

    Article  Google Scholar 

  • Wright, E. O. (1985). Classes (pp. 37–42). London: Verso.

    Google Scholar 

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Correspondence to Rakhal Gaitonde .

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Gaitonde, R. (2018). Conceptual Approaches to Examining Health Inequities. In: Ravindran, T., Gaitonde, R. (eds) Health Inequities in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-5089-3_2

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