Table 3 Typology of actions to reduce health inequalities with underlying programme theory ([22], pp. 474–475)
Level of actiona | Underlying cause of heath inequality | Underlying programme theory |
|---|---|---|
1) Strengthening individuals (using person-based strategies to improve the health of the most disadvantaged) | A perceived personal deficit, e.g. lack of knowledge, skills, beliefs, self-esteem | Actions that acknowledge positive strengths (i.e. assets and capabilities disadvantaged individuals possess) and remove barriers to achieving them will allow individuals to act in ways that improve their health |
2) Strengthening communities (building social cohesion and mutual support to improve the health of disadvantaged communities) | Greater social exclusion, isolation or powerlessness in disadvantaged communities | Fostering social interactions between members of the same community (horizontal interventions) could influence their local environment leading to healthier neighbourhoods. Improving social interactions across society (vertical interventions) produces a less divided society, builds inclusiveness and increases equitable access to resources for health |
3) Improving living and working conditions (improving infrastructure and access to services) | Greater exposure to health-damaging living and working environments with declining social position and poorer access to essential goods and services | Improving the physical environment and addressing psychosocial health hazards have the potential to improve the health of the whole population especially that of people living in the poorest conditions, thereby reducing the gradient in health |
4) Promoting healthy macro policies (making structural alterations to economic, cultural and environmental conditions to influence the standard of living of the whole population) | The standard of living, income, unemployment, job security, etc., are linked to wider macro-economic, cultural and environment conditions | Universal actions that aim to alter the macro-environment or cultural environment to reduce poverty span several sectors and work across the whole population. These actions are potentially more efficient in reducing poverty and tackling the socio-economic gradient |