Систематизация социально-экономических факторов, определяющих неравенство в здоровье: литературный обзор

Abstract

Academic and expert community is continuously researching all aspects of inequality. However, problems of inequality in healthcare (due to objective circumstances (ethnicity, gender, etc.) and settings in which people are born, grow up, work, and age) have been studied to a lesser extent. The study aims to summarize and analyze literature on the identification and systematization of socioeconomic factors affecting inequality in health on individual and population levels. Health factors are primarily determined by a person's socioeconomic position (SEP), including education, income, and occupation. Socio-economic factors that determine inequality in health are all factors that affect the absolute and relative (relative to other members of the society in which the individual lives) social and economic situation of a person. In addition to them, the analysis includes institutions that potentially influence a person's health: a person, at their own free will or in connection with established norms, interacts with these institutions regularly during their life. A literature review using the PubMed, Web of Science, Scopus, Russian Science Citation Index databases was carried out. The search depth by the time parameter had no restrictions. The keywords “socioeconomic status”, “socioeconomic position”, “inequality in health”, “health factors” were used to analyze more than 350 publications. The analysis allowed us to divide socioeconomic factors into the following categories and subcategories related to education (level of education of a person, level of education of a partner, gender differences in education, medical awareness), welfare and financial security (level of income, income inequality in society, macroeconomic parameters), employment and labor relations (nature and conditions of work, support of employment by the state), environmental factors (ecology and climate, physical habitat, social environment, health care). The factors are also systematized according to the levels of influence: individual level (micro-level), a person's inner circle (meso-level), and society as a whole (macro-level). The study identifies the relationship between various aspects of a person's SEP and their health for the majority of the factor groups for both developed and developing countries. The study results amend and strengthen arguments confirming the importance of the effective functioning of institutions responsible for the health of the population and explain their institutional roles for improving the quality of life and well-being of citizens throughout their life trajectories. In this regard, a systematic study of the factors that determine inequality in health creates conditions for improving the quality of the institutional framework and substantiating the effectiveness of measures aimed at minimizing inequality in health at the micro-, meso-, macro-levels for increasing the well-being of the entire socioeconomic system.