Upstream approaches to reducing socioeconomic inequalities in health

Kaplan, George A.

doi:10.1590/s1415-790x2002000400004

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…We highlight, among them, differences in access to opportunities in life (Kaplan, 2002), increase in social exclusion, conflicts and damage to social cohesion (Kawachi, 2000), lack of control and loss of respect (Wilkinson, 2003), and different possibilities of control and participation in social life by means of status, hierarchy and power (Marmot, 1999). These findings have stimulated investigations that explore the relation between social environment and health.…”

Section: Social Inequalities and Healthmentioning

confidence: 92%

A utilização da variável raça/cor em Saúde Pública: possibilidades e limites

Araújo

Costa

Hogan³

et al. 2009

Interface (Botucatu)

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This study aimed to discuss the use of the race/color variable as a determining factor of social difference and social exposure to the risk of illness and death. It is a reflection on the present production of the national and international literature in the Public Health and Epidemiology field on this subject. The study examined 47 original and review papers in the period 1990 to 2005. It was observed that international studies have aimed to debate and ground the use of the race/color variable in the health field. In Brazil, the use of this variable in studies about health inequalities is still incipient, but within the few investigations performed, differentials have been evidenced, which instigates the production of further research in this direction. The study of the role of race/color in the production of health differentials could contribute to make policies focusing on reducing health inequalities. Key words: Social difference. Health. Race/color. Public Health. RESUMO Propôs-se discutir o uso da variável raça/cor como fator determinante de desigualdades sociais e de exposição social ao risco de adoecimento e morte. Trata-se de uma reflexão sobre a produção atual da literatura nacional e internacional da área de Saúde Pública/Epidemiologia. Foram incluídos no estudo 47 artigos originais e de revisão no período de 1990 a 2005. Observou-se que os estudos internacionais procuram debater e fundamentar o uso da variável raça/cor no campo da saúde. No Brasil, a utilização dessa variável em estudos de desigualdade em saúde é ainda incipiente, mas, entre as poucas investigações realizadas, têm sido evidenciados diferenciais que instigam maior produção de pesquisas nessa direção. Investigações sobre o papel da raça/cor na produção de diferenciais em saúde poderão produzir informações capazes de contribuir para a elaboração de políticas destinadas a reduzir desigualdades em saúde. Palavras-chave: Desigualdade social. Saúde. Raça/cor. Saúde Coletiva RESUMEN Se propone discutir el uso de la variable raza/color como factor determinante de desigualdades sociales y de exposición social al riesgo de adolecer y de muerte. Se trata de una reflexión sobre la producción actual de la literatura brasileña e internacional del área de Salud Pública/Epidemiología. Se incluyen en el estudio 47 artículos originales y de revisión en el periodo de 1990 a 2005. Se observa que los estudios internacionales tratan de debater y fundamentar el uso de la variable raza/color en el campo de la salud. En Brasil la utilización de esta variable en estudios de desigualdad en salud es todavía incipiente, pero entre las pocas investigaciones realizadas se han evidenciado diferenciales que instigan mayor producción de investigaciones en esta dirección. Investigaciones sobre el papel de la raza/color en la producción de diferenciales en salud podrán producir informaciones capaces de contribuir a la elaboración de políticas destinadas a reducir desigualdades en salud.

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Section: Social Inequalities and Healthmentioning

confidence: 92%

A utilização da variável raça/cor em Saúde Pública: possibilidades e limites

Araújo

Costa

Hogan³

et al. 2009

Interface (Botucatu)

View full text Add to dashboard Cite

show abstract

“…smoke-free legislation). In contrast, where authors centred the importance of economic inequality in driving health inequalities, 18 , 27–29 ‘upstream’ policies were those which involved redistribution and ‘fundamental social reform’ 29 to raise the incomes of low-wage workers, improve education and employment opportunities, and provide a safety net against poverty. 28 Lastly, for those authors who centred the role of social norms and power relations in shaping personal autonomy and risk exposure, 17 , 30 ‘upstream’ programmes were those which could be explicitly linked to a broader political project of, for example, achieving gender equity through wider social change.…”

Section: Resultsmentioning

confidence: 99%

Framing action to reduce health inequalities: what is argued for through use of the ‘upstream–downstream’ metaphor?

McMahon

2021

Journal of Public Health

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Background Public health insights struggle to compete with dominant ideas which frame health inequalities as a problem of individual behaviour. There is consequently a need to critically reflect upon and question the effectiveness of different strategies for framing and communicating key insights. Taking the example of the ‘upstream–downstream’ metaphor, this literature review contributes to a necessary first step by asking what exactly is being argued for through its use. Methods An iterative search strategy was used to identify peer-reviewed articles which could contribute to the review question. A discourse analysis framework informed data extraction and synthesis of 24 articles. Articles were subsequently categorized into groups which reflected the different uses of the metaphor identified. Results All authors used the metaphor to promote a particular causal understanding of health inequalities, leading some to recommend policies and programmes, and others to focus on implementation processes. This seemingly simple metaphor has evolved beyond differentiating ‘upstream’ from ‘downstream’ determinants, to communicate an ambitious politically engaged agenda for change. Conclusions The metaphor is not without its critics and in light of the complexity of the arguments encapsulated in its use, work is needed to establish if it can, and does, resonate as intended with wider audiences.

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“…8 There are different ways of measuring the extent and magnitude of the associations between socioeconomic inequalities and health: income, schooling, social class and other composite variables. Occupation-based social classes, which are most frequently used in the United Kingdom, identify a gradient between social class and health.…”

Section: Introductionmentioning

confidence: 99%

Situação do indivíduo no mercado de trabalho e iniqüidade em saúde no Brasil

Giatti

Barreto

2006

Rev. Saúde Pública

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ObjectiveTo investigate inequalities in personal health conditions and in the utilization of healthcare services according in relation to the individual's status in the labor market. Methods This study was based on 39,925 males aged 15 to 64 years living in 10 Brazilian metropolitan regions, who took part in the 1998 National Household Survey. They were classified as formal labor, informal labor, unemployed or outside of the labor market. Each category was compared with formal labor regarding sociodemographic characteristics, health status indicators and healthcare utilization. This analysis was by means of Pearson's Chi-square test. Multinomial logistic regression was used to investigate independent associations between labor market status, health status indicators and healthcare utilization. ResultsThe classification of the participants' status was that 52.2% were formal labor, 27.7% informal labor, 10% unemployed and 10.2% were outside of the labor market. There were significant differences between these categories with respect to age, schooling, household income, household status and region of residence. Independent of the sociodemographic characteristics, unemployment, informal labor status and, especially, exclusion from the labor market remained associated with poor health status. Conclusions The individual's status in the labor market is expressed through a gradient of inequality in health conditions. These findings reinforce the need to also consider the individual's status in the labor market in studies on healthcare inequalities. restricted group of workers, while precarious contracts have proliferated along with unemployment.Unemployment is probably the main factor leading to social exclusion. 13 Workers who are excluded from the formal economy are forced to earn their living by means of precarious occupations or, after long periods without work, are stricken by exclusion, descending a slope from inclusion to precarious inclusion and, finally, exclusion. Therefore, it can be said that exclu-

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Upstream approaches to reducing socioeconomic inequalities in health

Cited by 3 publications

References 36 publications

A utilização da variável raça/cor em Saúde Pública: possibilidades e limites

A utilização da variável raça/cor em Saúde Pública: possibilidades e limites

Framing action to reduce health inequalities: what is argued for through use of the ‘upstream–downstream’ metaphor?

Situação do indivíduo no mercado de trabalho e iniqüidade em saúde no Brasil

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