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Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews

Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M - J Epidemiol Community Health (2009)

Bottom Line: Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport.Generally, the effects of interventions on health inequalities were unclear.Intervention studies that address inequalities in health are a priority area for future public health research.

Affiliation: Department of Geography, Wolfson Research Institute, Durham University Queen's Campus, Stockton on Tees TS17 6BH, UK. clare.bambra@durham.ac.uk

ABSTRACT

Background: There is increasing pressure to tackle the wider social determinants of health through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development.

Methods: Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport.

Results: Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, particularly interventions in the fields of housing and the work environment.

Conclusion: Intervention studies that address inequalities in health are a priority area for future public health research.

Dahlgren and Whitehead's model of the social determinants of health.
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fig1: Dahlgren and Whitehead's model of the social determinants of health.

Mentions: We used the widely cited Dahlgren and Whitehead rainbow model of the main determinants of health (figure 1) as a framework to help to identify the range of social determinants upon which interventions could be based.14 We concentrated on the outer two layers, which included macroeconomic, cultural and environmental conditions in the outermost layer; and living and working conditions and access to essential goods and services in the next layer, specifically water and sanitation, agriculture and food, access to health (and social care) services, unemployment (and welfare), work conditions, housing (and living environment), education and transport. We therefore excluded reviews that only examined interventions based on the inner most layers of the rainbow: individual lifestyle factors and social and community networks.

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Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews

Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M - J Epidemiol Community Health (2009)

Dahlgren and Whitehead's model of the social determinants of health.
© Copyright Policy
fig1: Dahlgren and Whitehead's model of the social determinants of health.
Mentions: We used the widely cited Dahlgren and Whitehead rainbow model of the main determinants of health (figure 1) as a framework to help to identify the range of social determinants upon which interventions could be based.14 We concentrated on the outer two layers, which included macroeconomic, cultural and environmental conditions in the outermost layer; and living and working conditions and access to essential goods and services in the next layer, specifically water and sanitation, agriculture and food, access to health (and social care) services, unemployment (and welfare), work conditions, housing (and living environment), education and transport. We therefore excluded reviews that only examined interventions based on the inner most layers of the rainbow: individual lifestyle factors and social and community networks.

Bottom Line: Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport.Generally, the effects of interventions on health inequalities were unclear.Intervention studies that address inequalities in health are a priority area for future public health research.

Affiliation: Department of Geography, Wolfson Research Institute, Durham University Queen's Campus, Stockton on Tees TS17 6BH, UK. clare.bambra@durham.ac.uk

ABSTRACT

Background:

Background: There is increasing pressure to tackle the wider social determinants of health through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development.

Methods: Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport.

Results: Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, particularly interventions in the fields of housing and the work environment.

Conclusion: Intervention studies that address inequalities in health are a priority area for future public health research.

View Similar Images In: Results  - Collection
View Article: Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2921286&rFormat=json&query=null&req=5