Social Mechanisms in Epidemiological Publications on Small-Area Health Inequalities—A Scoping Review

Abstract

Background: Small-area social mechanisms-social processes involving the social environment around the place of residence-may be playing a role in the production of health inequalities. Understanding how small-area health inequalities (social environment affects health and consequently contribute to inequalities between areas) are generated and the role of social mechanisms in this process may help defining interventions to reduce inequalities. In mediation and pathway analyses, social mechanisms need to be treated as processes or factors. We aimed to identify which types of social mechanisms explaining the process leading from small-area characteristics to health inequalities have been considered and investigated in epidemiological publications and to establish how they have been operationalized. Methods: We performed a scoping review for social mechanisms in the context of small-area health inequalities in the database PubMed. Epidemiological publications identified were categorized according to the typology proposed by Galster (social networks, social contagion, collective socialization, social cohesion, competition, relative deprivation, and parental mediation). Furthermore, we assessed whether the mechanisms were operationalized at the micro or macro level and whether mechanisms were considered as processes or merely as exposure factors. Results: We retrieved 1,019 studies, 15 thereof were included in our analysis. Eight forms of operationalization were found in the category social networks and another nine in the category social cohesion. Other categories were hardly represented. Furthermore, all studies were cross sectional and did not consider mechanisms as processes. Except for one, all studies treated mechanisms merely as factors whose respective association to health outcomes was tested. Conclusion: In epidemiological publications, social mechanisms in studies on small-area effects on health inequalities are not operationalized as processes in which these mechanisms would play a role. Rather, the focus is on studying associations. To understand the production of health inequalities and the causal effect of social mechanisms on health, it is necessary to analyze mechanisms as processes. For this purpose, methods such as complex system modeling should be considered.

Using agent-based modelling to test hypotheses on the role of neighbourhood social mechanisms in the development of small-area health inequalities

“…But while some social mechanisms can be operationalised as attributes of a neighbourhood via individual perception (social cohesion), others are processes (social contagion) and more difficult to operationalise in order to be studied within the framework of regression analysis. 7 Accordingly, in a recent literature review, we could not identify any studies with a focus on the effect of social contagion as a mechanism in the production of small-area health inequalities. 7 However, some evidence on the role of social contagion in a small-area context has been established.…”

“…7 Accordingly, in a recent literature review, we could not identify any studies with a focus on the effect of social contagion as a mechanism in the production of small-area health inequalities. 7 However, some evidence on the role of social contagion in a small-area context has been established. For example, Hedström et al showed how social contagion occurs in social networks with political interests.…”

Incidence, Racial Disparities and Factors Related to Psychosis among Black Individuals in Canada: A Scoping Review

“…The strategy was informed by previous reviews conducted among Black communities, [32][33][34][35][36][37] on mental health and psychosis [38][39][40][41] as well as on health inequalities more generally. [42][43][44] In addition, search lines relating to Canada and its provinces and territories were devised and used in combination with the three concepts mentioned. The final search strategy included relevant subject headings and keywords.…”

Incidence, factors, and disparities related to cancer among Black individuals in Canada: A scoping review

“…Strategies from previous reviews were reviewed to inform and design the search used in this review. Reviews on Black individuals and communities [23][24][25] on cancer [26][27][28] and health inequalities [29][30][31] were considered. The final search strategy included relevant subject headings and keywords and was executed on December 15, 2021.…”