Social inequality in health: Dichotomy or gradient?

Vallgårda, Signild

doi:10.1016/j.healthpol.2007.07.004

Cited by 41 publications

(16 citation statements)

References 25 publications

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“…In the former there was greater emphasis on health inequalities as caused by behaviours of the disadvantaged, whereas in the latter it was more material-structural factors (eg, income, working conditions and social structures). 33 …”

Section: Resultsmentioning

confidence: 99%

“…However, Vallgarda points out that data on health inequalities were available in the United Kingdom, Denmark, and Sweden long before the issue came to receive political attention, and suggests that increasing knowledge is not crucial. 33 Smith describes a low-level ‘appetite’ for SDHI policies among the general public, media and politicians. 39 Gauld et al describe a low-level of awareness about population health in New Zealand government agencies outside of the health sector.…”

Section: Resultsmentioning

confidence: 99%

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What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

Baker

Friel

Kay

et al. 2017

Int J Health Policy Manag

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Background: Despite decades of evidence gathering and calls for action, few countries have systematically attenuated health inequities (HI) through action on the social determinants of health (SDH). This is at least partly because doing so presents a significant political and policy challenge. This paper explores this challenge through a review of the empirical literature, asking: what factors have enabled and constrained the inclusion of the social determinants of health inequities (SDHI) in government policy agendas? Methods: A narrative review method was adopted involving three steps: first, drawing upon political science theories on agenda-setting, an integrated theoretical framework was developed to guide the review; second, a systematic search of scholarly databases for relevant literature; and third, qualitative analysis of the data and thematic synthesis of the results. Studies were included if they were empirical, met specified quality criteria, and identified factors that enabled or constrained the inclusion of the SDHI in government policy agendas. Results: A total of 48 studies were included in the final synthesis, with studies spanning a number of country-contexts and jurisdictional settings, and employing a diversity of theoretical frameworks. Influential factors included the ways in which the SDHI were framed in public, media and political discourse; emerging data and evidence describing health inequalities; limited supporting evidence and misalignment of proposed solutions with existing policy and institutional arrangements; institutionalised norms and ideologies (ie, belief systems) that are antithetical to a SDH approach including neoliberalism, the medicalisation of health and racism; civil society mobilization; leadership; and changes in government. Conclusion: A complex set of interrelated, context-dependent and dynamic factors influence the inclusion or neglect of the SDHI in government policy agendas. It is better to think about these factors as increasing (or decreasing) the ‘probability’ of health equity reaching a government agenda, rather than in terms of ‘necessity’ or ‘sufficiency.’ Understanding these factors may help advocates develop strategies for generating political priority for attenuating HI in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

Baker

Friel

Kay

et al. 2017

Int J Health Policy Manag

View full text Add to dashboard Cite

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“…These varying strategies may be a result of the organisation of the health care services and more specifically the general practitioners. In Denmark, general practitioners run private practices though they receive the main part of their income from public funds from the health insurance managed by the regional authorities [9,40]. They have independent practices and there is no national strategy for general practitioners to follow regarding health care management of refugees.…”

Section: Discussionmentioning

confidence: 99%

How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

et al. 2013

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BackgroundRefugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems.MethodsThe study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis.ResultsOne of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms.ConclusionGeneral practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.

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“…The welfare states that emerged in both Denmark and Norway after World War II were marked by a discourse about social equality and solidarity as guiding values in their development (Juul Hansen, ). A foundational principle of both Danish and Norwegian welfare states is that all citizens have the right to receive a number of shared services based on statutory requirements (Esping‐Andersen, ; Mik‐Meyer, ; Vallgårda, , ). Central is the notion that the public sector has primary responsibility for the welfare of all citizens.…”

Section: Results Of the Analysismentioning

confidence: 99%

“…Despite specific differences, the Nordic welfare states are often characterised as similar (Vallgårda, ). The basic principle is that all citizens have the right to a number of shared services based on statutory requirements and not on an assessment of whether or not the individual is in need (Esping‐Andersen, ; Mik‐Meyer, ; Vallgårda, , , ). Since World War II, and especially since the 1960s, the costs associated with health and welfare have expanded dramatically.…”

Section: Discussionmentioning

confidence: 99%

In search of the changeable: An analysis of visual representations of nursing in Norwegian and Danish professional nursing journals, 1965–2016

et al. 2020

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In this study, we demonstrate how perceptions of nursing are constructed in close connection with the development of the Nordic welfare states. Drawing on Gillian Rose's framework for analysing the social and political implications of visual materials, we analysed selected visual representations of nursing published in Danish and Norwegian professional nursing journals in the period 1965 to 2016. The analyses were conducted in an iterative process in three phases. First, we reviewed all visuals spanning the entire period to obtain an overview of developmental trends in the material. Second, selected visuals and associated captions were subjected to more thorough analysis. Third, we further examined and discussed the visuals in light of societal and political movements and ideologies in Danish and Norwegian healthcare policies over this period. Our analysis shows that visual representations of the nurse–patient relationship and of the patient's and the nurse's roles and responsibilities changed over this period and that the visualisations corresponded with and supported developments in the Danish and Norwegian welfare states as these first consolidated and then moved towards individualisation and the competition state. Our study demonstrates that nurses in these states are political actors implementing health policies embedded in various knowledge regimes.

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Social inequality in health: Dichotomy or gradient?

Cited by 41 publications

References 25 publications

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

In search of the changeable: An analysis of visual representations of nursing in Norwegian and Danish professional nursing journals, 1965–2016

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