WIDER SOCIAL DETERMINANTS OF HEALTH
Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews
Background
This project aimed to identify existing systematic reviews (from 2000-2007) and primary studies evaluating the effects of interventions addressing inequalities in health and to use this evidence to identify priorities for new research (systematic reviews and primary studies). Systematic review methods were used to locate and evaluate published and unpublished systematic reviews of interventions around the social determinants of health including living and working conditions and access to essential goods and services; water and sanitation; agriculture and food production; health (and social care) services; unemployment (and welfare); the work environment; housing, community, regeneration and crime; education, and transport. The reviews were critically appraised, findings were extracted and tabulated. Where available information was also extracted on inequalities and implementation issues, along with any research recommendations. Searches were carried out to identify recently published primary intervention studies and these were data extracted and considered alongside the review evidence.Findings
We identified 32 systematic reviews and 16 primary studies. There is some evidence that certain categories of intervention may impact positively on inequalities, in particular interventions in the field of housing and employment, though further evidence is needed. Housing improvements may positively affect physical health but the effects are likely to be small. The effects of changes in employment are experienced differently by employees in different occupational categories and some evidence about how this might be addressed; suggesting that the workplace might be an important setting to address inequalities. It is important to assemble new evidence on the mechanisms by which policies addressing the social determinants of health may affect health as this will help to identify points at which to intervene and will provide a framework for the development of new primary research.
Conducted by: Bambra C1, Gibson M2, Petticrew M3, Sowden A4, Whitehead M5, Wright K41. Centre for Public Policy & Health, Durham University;
2. MRC Social and Public Health Sciences Unit, Glasgow;
3. Public and Environment Health Research Unit, London School of Hygiene and Tropical Medicine;
4. Centre for Reviews and Dissemination; 5. Division of Public Health, University of Liverpool
Publications
Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010; 64(4):284-91
Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petticrew M. Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment. Prev Med. 2009; 48(5): 454-61
Bambra C, Gibson M, Sowden AJ, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. PHRC Project Outputs 2008; Executive Summary, Short Report and Final Report
Gibson M, Petticrew M, Bambra C, Sowden A, Wright K, Whitehead M. Housing and health inequalities: a synthesis of systematic reviews of interventions aimed at different pathways linking housing and health. Health & Place. 2010; [In press] doi:10.1016/j.healthplace.2010.09.011Funding
Commissioned by the Department of Health Policy Research Programme, via The Public Health Research Consortium
Status: Completed