J Epidemiol Community Health 67:286-291 doi:10.1136/jech-2011-200363
  • Theory and methods

A new typology of policies to tackle health inequalities and scenarios of impact based on Rose's population approach

  1. José Miguel Martínez1,2,6
  1. 1Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
  2. 2CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  3. 3Agència de Salut Pública de Barcelona, IIB-Sant Pau, Barcelona, Spain
  4. 4Unitat Docent de Medicina Preventiva i Salut Pública PSMAR-UPF-ASPB, Barcelona, Spain
  5. 5School of Public Health, University of Alberta, Canada
  6. 6Occupational Health Research Center (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
  1. Correspondence to Dr Joan Benach, Health Inequalities Research Group, Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra (UPF), Passeig de Circumval•lació, 8, 08003 Barcelona; joan.benach{at}
  1. Contributors All authors conceived the manuscript. JB and DM wrote the first and subsequent drafts of the manuscript. DM prepared the figures, with assistance from JMM, and the policy examples. All authors critically reviewed the drafts and accepted the final version of the manuscript. JB and DM are joint first authors.

  • Accepted 21 May 2012
  • Published Online First 17 August 2012


The last decade has witnessed a surge in interest for policies to tackle health inequalities. Adequate theoretical development of policy models is needed to understand how to design and evaluate equity-oriented health policies. In this paper we review Graham's typology of policies (focused on the worst-off, on the gap, or on the gradient) and propose an adaptation (targeted, universal with additional targeting, redistributive, and proportionate universalism). For each type, potential scenarios of impact on population health and health inequalities are depicted following the idea of Geoffrey Rose's population curves and strategies, policy examples are given and a simulation with survey data is shown. The proposed typology of scenarios of health inequality reduction can serve as an effective tool to interpret the differential impact of interventions and to reflect on how to adequately design or re-orient a policy and which measures to use to evaluate it.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.