Institute of Sociology NASU

SOCIAL INEQUALITIES IN HEALTH: MAIN APPROACHES TO STUDY

stmm. 2022 (1): 106-123

DOI https://doi.org/10.15407/sociology2022.01.106

IRYNA MAZHAK, Candidate of Sciences in Sociology, Associate Professor, Department of Sociology, Faculty of Social Sciences and Social Technologies, National University of “Kyiv-Mohyla Academy” (2, Hryhoria Skovorody St., Kyiv, 04655)

i.mazhak@ukma.edu.ua

https://orcid.org/0000-0003-0190-0126

Over the past four decades, researchers have used different theoretical and methodological approaches to study social inequalities in health, so the aim of this study is to analyze the main approaches to studying social and socio-economic inequalities in health: materialist (based on income), psychosocial (based on social inequalities), cultural and behavioral (based on health / lifestyle behaviors) and intersectional (used to identify social inequalities in health among many social groups appear at the intersection between different identities of the individual). There are also the fundamental cause theory, in which SES and social class are defined as the "fundamental cause" of health, disease, disability and death, and the life-course theory covering all the models that explain health inequalities within research of social inequalities in health.

Social inequalities in health are understood as differences in health between social groups based on such social determinants as gender, age, income, level of education, occupation, employment / unemployment, marital status, presence of children in the family, living conditions, place of residence, etc., which are reproducing over the time. Social inequalities in health are unjust, so in civilized societies governments tackling social inequalities in health. Health equity means that everyone should be able to reach their full potential in health. Health equity is not the same as health equality, because those who have greater needs but fewer resources need more support to equalize opportunities.

Empirical studies, including those conducted in Ukraine, have shown the relationship between different social and economic determinants and health inequalities and have confirmed the existence of social inequalities in health among different socio-economic and demographic groups.

Keywords: social inequalities in health; materialist, psychosocial, cultural-behavioral and intersectional approaches to study health inequalities; fundamental cause theory; life-course theory.

References

Abel, T. (2008). Cultural capital and social inequality in health. Journal of Epidemiology & Community Health, 62 (7), e13.

Aldabe, B., Anderson, R., Lyly-Yrjänäinen, M., Parent-Thirion, A., Vermeylen, G., Kelleher, C. C., Niedhammer, I. (2011). Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe. Journal of Epidemiology & Community Health, 65(12), 1123–1131.

Bambra, C. (2011). Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’. Journal of Epidemiology & Community Health, 65(9), 740–745.

Bartley, M. (2017). Health Inequality: An Introduction to Concepts Theories and Metods. S.l.: Polity Press.

Bobak, M., Murphy, M., Rose, R., Marmot, M. (2007). Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis. Journal of Epidemiology & Community Health, 61(11), 990–996.

Bobak, M., Pikhart, H., Rose, R., Hertzman, C., Marmot, M. (2000). Socioeconomic factors, material inequalities, and perceived control in self-rated health: cross-sectional data from seven post-communist countries. Social science & medicine, 51(9), 1343–1350.

Braveman, P., Arkin, E., Orleans, T., Proctor, D., Acker, J., Plough, A. (2018). What is health equity?. Behavioral Science & Policy, 4(1), 1–14.

Chan, T.W., Goldthorpe, J.H. (2007). Class and status: The conceptual distinction and its empirical relevance. American sociological review, 72(4), 512–532.

Cockerham, W.C. (2021). The social causes of health and disease. S.l.: John Wiley & Sons.

Cockerham, W.C., Hamby, B.W., Hankivsky, O., Baker, E.H., Rouhani, S. (2017). Self-rated health and barriers to healthcare in Ukraine: The pivotal role of gender and its intersections. Communist and Post-Communist Studies, 50(1), 53–63.

Dahlgren, G., Whitehead, M. (2006). European strategies for tackling social inequities in health: Levelling up Part 2. S.l.

Demirchyan, A., Petrosyan, V., Thompson, M.E. (2012). Gender differences in predictors of self-rated health in Armenia: a population-based study of an economy in transition. International Journal for equity in health, 11(1), 1–10.

Eikemo, T.A., Bambra, C., Huijts, T., Fitzgerald, R. (2017). The first pan-European sociological health inequalities survey of the general population: the European Social Survey rotating module on the social determinants of health. European Sociological Review, 33(1), 137–153.

Espelt, A., Borrell, C., Rodriguez-Sanz, M., Muntaner, C., Pasarin, M.I., Benach, J., et al. (2008). Inequalities in health by social class dimensions in European countries of different political traditions. International journal of epidemiology, 37(5), 1095–1105.

Forster, T., Kentikelenis, A., Bambra, C. (2018). Health inequalities in Europe: setting the stage for progressive policy action. S.l.

Freese, J., & Lutfey, K. (2011). Fundamental causality: challenges of an animating concept for medical sociology. In: Handbook of the sociology of health, illness, and healing (pp. 67–81). Springer, New York, NY.

Gilmore, A.B., McKee, M., Rose, R. (2002). Determinants of and inequalities in self-perceived health in Ukraine. Social science & medicine, 55(12), 2177–2188.

Gkiouleka, A., Huijts, T., Beckfield, J., Bambra, C. (2018). Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions-A research agenda. Social Science & Medicine, 200, 92–98.

Grad, F.P. (2002). The preamble of the constitution of the World Health Organization. Bulletin of the World Health Organization, 80, 981–981.

Gray, A.M. (1982). Inequalities in health. The Black Report: a summary and comment. International Journal of Health Services, 12(3), 349–380.

Hankivsky, O. (2014). Intersectionality 101. The Institute for Intersectionality Research & Policy, SFU, 36, 1–34.

Heyns, B. (2005). Emerging inequalities in central and Eastern Europe. Annu. Rev. Sociol., 31, 163–197.

Huber, M., Knottnerus, J.A., Green, L., Van Der Horst, H., Jadad, A.R., Kromhout, D., et al. (2011). How should we define health? BMJ, 343.

Jakab, Z., Marmot, M. (2012). Social determinants of health in Europe. The Lancet, 379(9811), 103–105.

Link, B.G., Phelan, J. (2010). Social conditions as fundamental causes of health inequalities. Handbook of medical sociology, 6(3), 17.

Mackenbach, J.P. (2012). The persistence of health inequalities in modern welfare states: the explanation of a paradox. Social Science & Medicine, 75(4), 761–769.

Mackenbach, J.P. (2019). Health Inequalities: Persistence and change in European welfare states. Oxford University Press.

Mackenbach, J. P., Stirbu, I., Roskam, A.J.R., Schaap, M.M., Menvielle, G., Leinsalu, M., Kunst, A.E. (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, 358(23), 2468–2481.

Marmot, M., Allen, J., Bell, R., Bloomer, E., Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. The Lancet, 380(9846), 1011–1029.

Mazhak, I. (2019). Health inequalities: who is the most disadvantaged among the Ukrainian working-age population? / Journal of the Academy of Labour, Social Relations and Tourism, 2, 85–101.

Mazhak, I. (2021). Social inequalities in health among the population of Ukraine of working age. [In Ukrainian]. The Bulletin of Lviv National University. Sociological Series, 54. [=Мажак 2021]

McCartney, G., Popham, F., McMaster, R., Cumbers, A. (2019). Defining health and health inequalities. Public Health, 172, 22–30.

Michalski, T. (2016). The differentiation of the health situation in European post-Communist countries after 1990. Geography and Tourism, 4(1).

Overcoming the COVID virus in Ukraine: initial estimates of its impact on poverty (s.a.). [In Ukrainian]. Retrieved from: https://www.unicef.org/ukraine/media/5811/file/COVID%20impact%20on%20poverty%20ukr.pdf [=Боротьба s.a.]

Palència, L., Malmusi, D., De Moortel, D., Artazcoz, L., Backhans, M., Vanroelen, C., Borrell, C. (2014). The influence of gender equality policies on gender inequalities in health in Europe. Social Science & Medicine, 117, 25–33.

Phelan, J.C., Link, B.G. (2013). Fundamental cause theory. In: Medical sociology on the move (pp. 105–125). Dordrecht: Springer/

Phelan, J.C., Link, B.G., Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. Journal of Health .and Social Behavior, 51 (1 suppl), 28–40.

Riley, A.R. (2020). Advancing the study of health inequality: fundamental causes as systems of exposure. SSM-population health, 10, 100–555.

Schütte, S., Chastang, J.F., Parent-Thirion, A., Vermeylen, G., Niedhammer, I. (2013). Social differences in self-reported health among men and women in 31 countries in Europe. Scandinavian Journal of Public Health, 41(1), 51–57.

Sen, G., Iyer, A., Mukherjee, C. (2009). A methodology to analyse the intersections of social inequalities in health. Journal of Human Development and Capabilities, 10(3), 397–415.

Simonchuk, O. (2020) Subjective assessments of health and medical services in the period of COVID and pre-epidemic period. [In Ukrainian]. In: V. Vorona, M. Shulga (Eds.), Ukrainian society: monitoring of social change, 7 (21), 60–80. [=Симончук 2020]

Social Determinants of Health (s.a.). World Health Organization. Retrieved from: http://www.who.int/social_determinants/sdh_definition/en/.

Whitehead, M., Dahlgren, G. (2006). Concepts and principles for tackling social inequities in health: Levelling up Part 1. World Health Organization: Studies on Social and Economic Determinants of Population Health, 2, 460–474.

Whitehead, M. (1991). The concepts and principles of equity and health. Health promotion international, 6(3), 217–228.

Whitehead, M., Dahlgren, G. (1991). What can be done about inequalities in health? The Lancet, 338(8774), 1059–1063.

Whitehead, M., Dahlgren, G. (2006). Concepts and principles for tackling social inequities in health: Levelling up Part 1. World Health Organization: Studies on Social and Economic Determinants of Population Health, 2, 460–474.

Wilkinson, R.G., Marmot, M. (1998). Social determinants of health: the solid facts. Copenhagen: WHO Regional Office for Europe.

World Health Organization (1948). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. Retrieved from: http://www. who. int/governance/eb/who_constitution_en. pdf

World Health Organization (s.a.). Health Topics. Retrieved from:http://www.who.int

WHO (2008). Retrieved from: http://www. who. int/health-equity#tab=tab_1

Received 13.02.2022