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Review
. 2022 Jul 8;19(14):8384.
doi: 10.3390/ijerph19148384.

A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach

Lisa Wilderink  1   2 , Ingrid Bakker  2 , Albertine J Schuit  3 , Jacob C Seidell  1 , Ioana A Pop  3 , Carry M Renders  1   2
Affiliations
Review

A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach

Lisa Wilderink et al. Int J Environ Res Public Health. .

Erratum in

Abstract

Despite policy intentions and many interventions aimed at reducing socioeconomic health inequalities in recent decades in the Netherlands and other affluent countries, these inequalities have not been reduced. Based on a narrative literature review, this paper aims to increase insight into why socioeconomic health inequalities are so persistent and build a way forward for improved approaches from a theoretical perspective. Firstly, we present relevant theories focusing on individual determinants of health-related behaviors. Thereafter, we present theories that take into account determinants of the individual level and the environmental level. Lastly, we show the complexity of the system of individual determinants, environmental determinants and behavior change for low socioeconomic position (SEP) groups and describe the next steps in developing and evaluating future effective approaches. These steps include systems thinking, a complex whole-system approach and participation of all stakeholders in system change.

Keywords: complex whole-system approach; narrative literature review; socioeconomic health inequalities; systems thinking; theoretical models.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
The main determinants of health. Reproduced with permission from Dahlgren, G. and Whitehead, M., European strategies for tackling social inequities in health; published by WHO, 2006.
Figure 2
Figure 2
The theory of planned behavior. Reproduced from Ajzen, I., From Intentions to Actions: A Theory of Planned Behavior; published by Springer, 1985.
Figure 3
Figure 3
The health belief model. Reproduced from Rosenstock, I.M., Historical origins of the health belief model; published by Health Education Monographs, 1974.
Figure 4
Figure 4
The stages of change model. Reproduced from Prochaska & Di Clemente, The transtheoretical model of health behavior change; published by The American Journal of Health Promotion, 1997.
Figure 5
Figure 5
Social capital as determinants of health. Reproduced with permission from Israel, B.A., Social networks and health status: Linking theory, research, and practice; Published by Patient Counselling and Health Education, 1982.
Figure 6
Figure 6
Structuration theory. Reproduced from Oppong, S., ‘Between Bandura and Giddens: Structuration Theory in Social Psychological Research?’; published by Psychological Thought, 2014 [56].
Figure 7
Figure 7
Social cognitive theory. Reproduced from Bandura, A., Human agency in social cognitive theory; published by American Psychologist, 1989.
Figure 8
Figure 8
Cultural capital theory.
Figure 9
Figure 9
The complex system of the person, ball and slope.
See this image and copyright information in PMC

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