A typology of actions to tackle social inequalities in health


 “If your only tool is a hammer, all your problems will be nails.” Mark Twain.

There is a growing acknowledgement that many countries face serious social inequalities in health, identified as one of the greatest challenges to public health today.1 “Social inequalities in health” in this article are defined as systematic differences in health between different socioeconomic groups within a society. As they are socially produced, they are potentially avoidable and are widely considered unacceptable in a civilised society.2 This paper uses the British convention of referring to “inequalities in health”, which commonly has the same meaning in the UK as the term “inequities in health”. That is, “inequalities” in the British context—and increasingly also across Europe—carries the same connotations of unfairness and injustice as the term “inequities”.

Previous articles in this series have dealt with how to measure health inequalities3,4 and socioeconomic position,5,6 together with the associated concepts.7,8 The central question remains: what can be done about these social inequalities in health? A growing number of countries are wrestling with this question and devising policies and interventions in attempts to tackle the challenge.9–11 This article organises some of the most prominent types of actions that have been devised in this field into a typology. The aim is to help broaden the understanding of the range of different interventions available and their potential effectiveness for the task in hand, and to avoid the tendency to focus on one type of intervention neglecting the others. As Mark Twain cautioned: “If your only tool is a hammer, all your problems will be nails”.

IDENTIFYING THE THEORY UNDERLYING INTERVENTIONS

Over the past two decades, theory-based approaches to the assessment of public policy and interventions have been elaborated in the general evaluation literature.12–14 The idea, as …