Micro, macro, but what about meso? The institutional context of health inequalities

Excerpt

Multilevel models that integrate associations between proximal and distant determinants of health have significantly improved our understanding of how health inequalities emerge. For example, it has been argued that the likelihood of being exposed to individual material, psychosocial and behavioural risk factors (micro-level) is strongly influenced by determinants at the macro-level (societal level) such as macroeconomic characteristics (income distribution, national wealth, and welfare), health care policy, or societal norms (CSDH 2008). Area-based measures of poverty and deprivation have also been found to be associated with health outcomes after adjustment for individual-level factors. The effects of these group-level variables on individual-level outcomes have been referred to as contextual effects (Sauzet and Leyland 2017). …