Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research

Kelly-Irving, Michelle; Ball, William; Bambra, Clare; Delpierre, Cyrille; Dundas, Ruth; Lynch, Julia; McCartney, Gerry; Smith, Katherine E.

doi:10.1080/09581596.2022.2036701

Cited by 26 publications

(9 citation statements)

References 67 publications

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“…But what kinds of evidence are available? This core section of the article provides support for the argument of progressive health researchers 20 (p2) who, without referring to epidemiological inertia, state that “when the broader canon of evidence from the social sciences is included it provides a rationale for clear causal inference and policy action.” Considering this broader canon of evidence can provide a high-level roadmap to various concepts, literatures, and repertoires of research design that, taken together, can provide a compelling case for action on social determinants of health. Key examples of this broader canon are grouped here into two conceptual clusters: epidemiological worlds and lifecourse studies and perspectives .…”

Section: So What To Do? a Richer Conceptual Armamentarium For Studyin...mentioning

confidence: 92%

Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities

Schrecker

2023

International Journal of Social Determinants of Health and Heal

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A dramatic increase in the volume of research literature referencing social determinants of health (SDH) since the report of the World Health Organization Commission on the topic in 2008 has not been matched by expansion of policies and interventions to reduce health inequalities by way of SDH. This article argues that familiar hierarchies of evidence that privilege clinical epidemiology as used in evidence-based medicine are inappropriate to address SDH. They misunderstand both the range of relevant evidence and the value-based nature of standards of proof. A richer conceptual armamentarium is available; it includes several applications of the concepts of epidemiological worlds and the lifecourse, which are explained in the article. A more appropriate evidentiary approach to SDH and health inequalities requires “downing the master's tools,” to adapt Audre Lorde's phrase, and instead applying a multidisciplinary approach to assessing the evidence that adequately reflects the complexity of the relevant causal pathways. Doing so is made more difficult by the power structures that shape research priorities, yet it is essential.

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Section: So What To Do? a Richer Conceptual Armamentarium For Studyin...mentioning

confidence: 92%

Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities

Schrecker

2023

International Journal of Social Determinants of Health and Heal

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“…If we had a much larger universe of developed democracies in which these three sets of macro-structures varied independently of one another, we might be able to use a correlational analysis to separate out the effects of each. But the available of countries is a relatively small one in which these macro-structures overlap-various types of welfare regimes, for example, accompany specific types of capitalism-and it is often in combination that they distribute the resources affecting health (Kelly-Irving et al 2023). Hence, it is difficult to account for national variations in the health gradient by reference to a single type of macro-structure or to arrive at precise estimates for the effects of one macro-structure compared with another.…”

Section: Cross-national Variation In Economic and Social Structuresmentioning

confidence: 99%

The Structural Sources of Socioeconomic Inequalities in Health: A Cross-National Perspective

Barnes

Hall

Taylor

2023

Socius: Sociological Research for a Dynamic World

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This article investigates how macro-level structures condition the sources of socioeconomic inequalities in health. Drawing on multiple social science disciplines, the authors develop theoretically grounded propositions about how different types of welfare states, varieties of capitalism, and social structures give rise to cross-national variations in the sources of health inequalities. They consider how these macro-level structures affect the distribution of five key resources important to health, estimate the relative contribution that each resource makes to health inequalities, and compare those contributions in 21 developed democracies. Moving beyond a current literature focused on welfare states, the authors show how different types of political economies and social structures also condition the health gradient. This research carries implications for policy and suggests agendas for further investigation into the relationship between macro-level structures and inequalities in health.

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“…At a national level, nancial support for sustained public health could be provided as part of welfare systems. There is debate whether the advanced welfare tax burden that egalitarian societies sustain offsets health inequalities due to socioeconomic status compared to more neoliberal welfare states [52]. Our belief is that the investigations into the causes for health inequalities should continue and are welcome because they will provide testable theories that can explain, for example, how physical activity improvements due to eHealth interventions wane differently depending on SES, and why.…”

Section: Ehealth Interventions and Mediamentioning

confidence: 99%

Effectiveness of eHealth Weight Management Interventions in Overweight and Obese Adults from Low Socioeconomic Groups: A Systematic Review

Myers-Ingram

Sampford

Milton-Cole

et al. 2022

Preprint

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Background Low socioeconomic status (SES) is associated with increased rates of overweight and obesity. Proponents of electronic health (eHealth) hypothesise that its inclusion in weight management interventions can improve efficacy by mitigating typical barriers associated with low SES. Objectives To establish the scope of eHealth weight management interventions for people with overweight and obesity from a low SES. Secondary objectives were to determine the efficacy of eHealth interventions in facilitating weight loss, physical activity, and fitness improvements. Methods Four databases and grey literature were systematically searched to identify eligible studies published in English from inception to May 2021. Studies examining an eHealth intervention with low SES participants were included. Outcomes included temporal change in weight and BMI, anthropometry, and physical activity levels. The number and heterogeneity of studies precluded any meta-analyses, thus a narrative review was undertaken. Results Four experimental studies with low risk of bias were reviewed. There was variance in how SES was defined. Study aims and eHealth media also varied and included reducing/maintaining weight or increasing physical activity using interactive websites or voice responses, periodic communication and discourse via telephone, social media, text messaging, or eNewsletters. Irrespectively, all studies reported short-term weight loss. eHealth interventions also increased short-term physical activity levels where it was assessed, but did not change anthropometry. None reported any effect on physical fitness. Conclusions This review revealed short-term effects of eHealth interventions on weight loss for low SES participants. Inter-study comparison is challenging because of considerable variability. Future work should prioritise how to utilise eHealth in the longer-term either as a supportive public health measure or by determining its long-term efficacy in engendering volitional health behaviour changes. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021243973 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021243973)

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Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research

Cited by 26 publications

References 67 publications

Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities

Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities

The Structural Sources of Socioeconomic Inequalities in Health: A Cross-National Perspective

Effectiveness of eHealth Weight Management Interventions in Overweight and Obese Adults from Low Socioeconomic Groups: A Systematic Review

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