Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews
- 1Department of Geography, Durham University, Durham, UK
- 2MRC Social and Public Health Sciences Unit, Glasgow, UK
- 3Centre for Reviews and Dissemination, University of York, York, UK
- 4Division of Public Health, University of Liverpool, Liverpool, UK
- 5Public and Environment Health Research Unit, London School of Hygiene and Tropical Medicine, London, UK
- Correspondence to Clare Bambra, Department of Geography, Wolfson Research Institute, Durham University Queen's Campus, Stockton on Tees TS17 6BH, UK;
Contributors CB participated in the design of the study, collected, analysed and synthesised the data; led the writing of the article; and is a guarantor. MG assisted with data collection, analysis and synthesis and contributed to the writing of the article. AS participated in the design of the study, assisted in analysis and synthesis and contributed to the writing of the article. KW participated in data collection and contributed to the writing of the article. MW assisted in analysis and synthesis and contributed to the writing of the article. MP participated in the design of the study, assisted in analysis and synthesis and contributed to the writing of the article. All the named authors approved the final version.
- Accepted 3 June 2009
- Published Online First 19 August 2009
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.
- health inequalities
- social determinants
- systematic review
- social inequalities
- unemployment and health
Funding The work was supported by the Public Health Research Consortium. The Public Health Research Consortium is funded by the English Department of Health Policy Research Programme. The views expressed in the publication are those of the authors and not necessarily those of the DH. Information about the wider programme of the PHRC is available from www.york.ac.uk/phrc. The funders had no involvement in the study design, execution or write-up. Other funders: Department of Health.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.