Who, and what, causes health inequities? Reflections on emerging debates from an exploratory Latin American/North American workshop

Krieger, Nancy; Alegrı́a, Margarita; Almeida-Filho, Naomar; Silva, Jarbas Barbosa da; Barreto, Maurício L.; Beckfield, Jason; Berkman, Lisa F.; Birn, Anne‐Emanuelle; Duncan, Bruce Bartholow; Franco, Saúl; Garcia, Dolores Acevedo; Gruskin, Sofia; James, Sherman A.; Laurell, Asa Christina; Schmidt, María Inês; Walters, Karina L.

doi:10.1136/jech.2009.106906

Cited by 56 publications

(53 citation statements)

References 4 publications

(5 reference statements)

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“…Health inequalities are increasingly viewed as an outcome of material, social and cultural inequalities across societies (Krieger, 2001;Whitehead and Dahlgren, 2007;Wilkinson and Pickett, 2009;Krieger et al, 2010) which are, in turn, the product of inequalities in power 4 (Bambra et al, 2005;Schulz and Mullings, 2006), income and wealth, knowledge, social status and social connections (Link and Phelan, 1995). Viewed from this perspective, sustained long-term reductions in health inequalities are almost certainly dependent on strategies that engage effectively with these root causes (Phelan et al, 2004;Scott et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Fantasy paradigms of health inequalities: Utopian thinking?

Scott-Samuel

Smith

2015

Soc Theory Health

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This paper argues that, while it can be politically expedient for governments to engage with health inequalities, they cannot, within the confines of neoliberalism, realistically propose actions that evidence suggests will effectively reduce them -such as tackling power inequalities, social status and connections or class inequality. Indeed, a dominant 'policy paradigm' prioritising economic growth restricts the ability of policy actors to imagine alternative, more equitable scenarios. In this context, some policy actors and researchers have devised a parallel fantasy world in which proximal, downstream, easily-tackled exposures are posited as potential solutions to health inequalities. The consequence of this is a widespread public sector culture in which well-meaning policy-makers, practitioners, researchers and members of the public collude in sustaining a 'cargo cult' of health behaviourism. In examining this situation, we draw on accounts and critiques of utopian thinking to help explain: (i) the remarkable persistence of policy proposals to tackle health inequalities via downstream interventions, in spite of the strength of evidence challenging such approaches; and (ii) the limited extent to which more upstream proposals inform policy debates. We argue Ruth Levitas' notion of 'utopia as method' offers an imaginative and potentially useful avenue for future health inequalities research.Abstract word count: 199

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Section: Introductionmentioning

confidence: 99%

Fantasy paradigms of health inequalities: Utopian thinking?

Scott-Samuel

Smith

2015

Soc Theory Health

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“…Mesmo sob a ameaça da cólera, a aprovação do Public Health Act não foi tranquila 17 , e custou à Chadwick seu cargo de 30 anos como funcionário público exemplar 16 . A situação da Inglaterra de 1848 não difere muito da realidade dos grandes centros urbanos dos países menos desenvolvidos atualmente 9 , entre eles, o Brasil. A tuberculose foi substituída pelas doenças do aparelho circulatório como primeira causa de óbito nas populações, mas para esta e outras causas de adoecimento e morte, persistem desigualdades sociais significativas na distribuição dos casos [20][21][22][23][24] .…”

Section: Palabras Claveunclassified

“…Como somar à produção e disseminação de conhecimentos já em curso 4,[6][7][8][9][10][30][31][32][33] , e contribuir para a redução das iniquidades e a melhoria da saúde urbana?…”

Section: Palabras Claveunclassified

“…Manter-se saudável depende da interação entre o ambiente e a capacidade de adaptação a ele 3-4 ou resiliência 4 . Mesmo com ênfases em aspectos diferentes, cada vez mais têm sido discutidos os efeitos deletérios do estresse decorrente das relações sociais na capacidade de adaptação dos indivíduos ao ambiente [5][6][7][8][9][10][11] . Enquanto uns autores enfocam as relações sociais entre indivíduos e entre grupos na vizinhança, outros enfatizam os contextos sociais, políticos e econômicos que as antecederam e condicionam 7 e que persistem cristalizados na cultura e nos lugares 12 (a habitação, o bairro, os ambientes de trabalho e a distribuição espacial dos equipamentos urbanos), tendendo a reproduzir os processos que lhes deram origem.…”

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Saúde urbana, ambiente e desigualdades

Azambuja

Achutti

Reis

et al. 2011

Rev Bras Med Fam Comunidade

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Os ambientes psicossocial, econômico e físico, nos quais se nasce, cresce, vive e trabalha, afetam a saúde e a longevidade, tanto quanto o fumo, o exercício e a dieta. A atenção individual à saúde não é suficiente para prevenir ou controlar os efeitos das más condições ambientais. Evidências históricas e atuais apontam para o agravamento das condições de saúde das populações mais pobres, acompanhando processos de urbanização rápida. Esperadamente, o envelhecimento populacional num ambiente urbano de desigualdade social deverá agravar a situação de saúde da população mais pobre, resultando em mais sofrimento e em perdas econômicas para o país. Com base nestas justificativas, um grupo de professores da Universidade Federal do Rio Grande do Sul se organizou, via extensão universitária, para contribuir com a discussão e as iniciativas nacionais de intervenção sobre a saúde urbana. Os projetos do grupo abarcam: o debate sobre o impacto potencial de iniciativas privadas e políticas públicas setoriais (de habitação, saneamento, transporte, educação, inovação tecnológica, sustentabilidade ambiental etc.) na saúde urbana; a produção e divulgação de conteúdos sobre determinantes sociais e ambientais da saúde; a produção e disseminação dos indicadores de desigualdade social dos determinantes da saúde; a formação de recursos humanos; e a participação em redes sociais. A apresentação pública deste projeto cumpre o objetivo de contribuir desde já com essa discussão.

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“…19 The real public health challenge is to explain how and why these disparities exist in order to properly inform policies and the development of programs aimed at reducing them. 31,50 The methods of classifying groups of populations have a direct impact on the ways health disparities are examined and interpreted. The theory and methods used to study racial and ethnic disparities have been the subject of important criticisms over the last decades in regards to public health and epidemiology.…”

mentioning

confidence: 99%

Persisting problems related to race and ethnicity in public health and epidemiology research

Moubarac

2013

Rev. Saúde Pública

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Article available from: www.scielo.br/rsp Persisting problems related to race and ethnicity in public health and epidemiology research Problemas persistentes relacionados à raça e etnia na pesquisa em saúde pública e epidemiologia ABSTRACT A recent and comprehensive review of the use of race and ethnicity in research that address health disparities in epidemiology and public health is provided. First it is described the theoretical basis upon which race and ethnicity differ drawing from previous work in anthropology, social science and public health. Second, it is presented a review of 280 articles published in high impacts factor journals in regards to public health and epidemiology from 2009-2011. An analytical grid enabled the examination of conceptual, theoretical and methodological questions related to the use of both concepts. The majority of articles reviewed were grounded in a theoretical framework and provided interpretations from various models. However, key problems identifi ed include a) a failure from researchers to differentiate between the concepts of race and ethnicity; b) an inappropriate use of racial categories to ascribe ethnicity; c) a lack of transparency in the methods used to assess both concepts; and d) failure to address limits associated with the construction of racial or ethnic taxonomies and their use. In conclusion, future studies examining health disparities should clearly establish the distinction between race and ethnicity, develop theoretically driven research and address specifi c questions about the relationships between race, ethnicity and health. One argue that one way to think about ethnicity, race and health is to dichotomize research into two sets of questions about the relationship between human diversity and health. A universal epidemiological fact is that health and disease are unevenly distributed across groups of populations, regardless of the way these are characterized either on the basis of race, ethnicity, nationality, religious affi liation, socioeconomic level, gender, and so on. Racial and ethnic disparities are reported in the United States for virtually all physical and mental health conditions, health-related risk factors, as well as in the use and quality of health care services. 19 The real public health challenge is to explain how and why these disparities exist in order to properly inform policies and the development of programs aimed at reducing them. DESCRIPTORS: 31,50The methods of classifying groups of populations have a direct impact on the ways health disparities are examined and interpreted. The theory and methods used to study racial and ethnic disparities have been the subject of important criticisms over the last decades in regards to public health and epidemiology. 5,6,10,13,14,16,22,27,28,30,35,38 Four comprehensive reviews have examined the use of race and ethnicity concepts in the fi elds of epidemiology and public health research. 1,12,25,56 These reviews revealed several key problems including: a) a failure from researchers to differenti...

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Who, and what, causes health inequities? Reflections on emerging debates from an exploratory Latin American/North American workshop

Cited by 56 publications

References 4 publications

Fantasy paradigms of health inequalities: Utopian thinking?

Fantasy paradigms of health inequalities: Utopian thinking?

Saúde urbana, ambiente e desigualdades

Persisting problems related to race and ethnicity in public health and epidemiology research

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