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What is the evidence that differences in ‘control over destiny’ lead to socioeconomic inequalities in health? A theory-led systematic review of high-quality longitudinal studies on pathways in the living environment
  1. Lois Catherine Orton1,
  2. Andy Pennington1,
  3. Shilpa Nayak1,
  4. Amanda Sowden2,
  5. Mark Petticrew3,
  6. Martin White4,
  7. Margaret Whitehead1
  1. 1 Department of Public Health & Policy, University of Liverpool, Liverpool, UK
  2. 2 CRD, University of York, York, UK
  3. 3 Public Health, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Lois Catherine Orton, Public Health & Policy, University of Liverpool, Liverpool L69 3GB, UK; l.c.orton{at}


Background Low control and high demand in the places where people work has been shown to partially explain why those in lower socioeconomic positions experience poorer health than their counterparts in higher socioeconomic positions. It would seem likely then that experiences of control in the wider living environment, beyond people’s places of work, might also play a role in shaping these health inequalities. Our recent review of theory revealed potential pathways by which low control in the living environment might explain the social patterning of health via low control beliefs and low actual control.

Methods Based on the potential pathways identified in our review of theory, we conducted a systematic review of longitudinal studies on the relationship between low control in the living environment and social inequalities in health published by January 2019, in English.

Results Six studies were included in the review. Taken together, they provide evidence that lower social positions are associated with lower control beliefs and poorer health outcomes, in terms of heart disease, anxiety, depression and self-rated health, and that some of the association between low social position and health outcomes is explained by low control beliefs. No studies investigated the pathway from low actual control to poorer health in more disadvantaged groups.

Conclusion There is strong evidence from a small number of high-quality longitudinal studies that low perceived control in the living environment may play an important role in the pathways leading from low social position to poorer health and well-being. Further studies are needed to distinguish between the effects of having low control beliefs and having actual low control.

  • control over destiny
  • socioeconomic status
  • inequalities
  • social determinants
  • health
  • systematic review

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  • Contributors MW conceived of the review published in this manuscript. LCO and AP conducted the review with supervision from MW and assistance from SN. LCO led in the writing of this manuscript with MW. AS, MP and MW guided the review process and the writing of this manuscript at all stages.

  • Funding This study was supported by Department of Health and Social Care Policy Research Programme.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.