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Kawachi et al. - A Glossary for Health Inequalities

Distinction between health inequality and health inequity

  • Health inequality: generic term used to designate differences, variations, and disparities in the health achievements of individuals and groups

    • Doesn’t imply moral judgment

  • Health inequity: inequalities in health that are deemed to be unfair or stemming from some form of injustice

  • Most of the health inequalities across social groups are unjust because they reflect an unfair distribution of the underlying social determinants of health

Measuring and assessing health inequalities

  • Measuring social group differences in health: defining certain social groups a priori and then examining the health differentials between them

    • Assumes the existence of meaningful social groupings that reflect the unequal distribution of resources and life opportunities across segments of society

  • Measuring the distribution of health status across individuals in a population: measures health inequality based on the distribution of health across individuals

Socioeconomic gradient or poverty

  • The socioeconomic gradient in health: the worse health of those who are at a lower level of socioeconomic position-whether measured by income, occupational grade, or educational attainment; even those who are already in relatively high socioeconomic groups

  • Not just the conditions associated with severe disadvantage that explain socioeconomic inequalities in health among those who have attained relatively high levels of socioeconomic position

Material deprivation or psychosocial mechanisms

  • The material interpretation of health inequalities: emphasises the graded relation between socioeconomic position and access to tangible material conditions

  • The psychosocial interpretation: ascribes the existence of health inequalities to the direct or indirect effects of stress stemming from either being lower on the socioeconomic hierarchy, or living under conditions of relative socioeconomic disadvantage

The absolute and relative income hypothesis in health inequalities

  • Absolute income hypothesis: an individual's health depends on their own level of income

  • Relative income hypothesis: health depends not just on one's own level of income, but also on the incomes of others in society

  • Social capital: the resources available to individuals and to society through social relationships

Unhealthy people or unhealthy places

  • Area or place effects: the health effects of variables that tell us something about the places or contexts, and not simply the people who inhabit them

  • Collective effect: aggregated group properties that exert an influence on health over and above individual characteristics

  • Contextual effect: the broader political, cultural, or institutional context, for example the presence or absence of features that are intrinsic to places, such as infrastructural resources, economic policies of states, social and public support programmes

  • Compositional explanation for area differences: ascribes the variations in health outcomes to the characteristics of individuals who reside in them

Life cours perspectives

  • Life course effects: how health status at any given age, for a given birth cohort, reflects not only contemporary conditions but embodiment of prior living circumstances, in utero onwards

  • Latent effects: the early life environment affects adult health independent of intervening experience

  • Pathway effects: the early life environment sets individuals onto life trajectories that in turn affect health status over time

  • Cumulative effects: the intensity and duration of exposure to unfavourable environments adversely affects health status, according to a dose-response relation

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