Briefing Paper 3: The social determinants of health inequalities: implications for research and practice

The previous two briefing papers have looked at "why health inequality matters", Briefing Paper (BP 1) and "how research conducted under the aegis of CLAHRC (SY) can address the issue of health inequality", Briefing Paper 2 (BP 2). The third paper in this series (BP 3) builds on some of the ideas outlined in these papers but focuses on understanding the fundamental or underlying causes of health inequalities – something that is clearly essential for all Public Health practitioners
working in NHS and other health organisations. What we seek to do in this briefing paper is to describe, discuss and critique the social epidemiology which provides the evidence base for our contemporary understanding of the causes of health inequalities. This is not a small task and it is not an uncontroversial one either. Much contemporary social epidemiology has produced evidence which seems to point to the argument that more unequal societies (and here what we
mean by unequal refers to socio-economic factors, such as income) have poorer health and well-being than more equal ones. This finding has generated a number of theories regarding what it might be about unequal societies that seems to cause such damage. This paper outlines both the evidence and the theories and looks at a range of recent work, including the Marmot Review (2010) and Wilkinson and Pickett's "The Spirit Level" (2009), which make important claims and raise basic questions about social determinants of health inequalities which in turn, generate questions for research, for policy and for practice.