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A new typology of policies to tackle health inequalities and scenarios of impact based on Rose's population approach
  1. Joan Benach1,2,
  2. Davide Malmusi2,3,4,
  3. Yutaka Yasui5,
  4. 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}


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.

  • Inequalities
  • public health
  • social inequalities
  • socioeconomic
  • self-rated health
  • gender
  • social class
  • epidemiology
  • methodology
  • multilevel modelling
  • occupational health
  • spatial analysis

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  • Competing interests None.

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