Abstract
BackgroundA strong focus on individual choice and behaviour informs interventions designed to reduce health inequalities in the UK. We review evidence for wider mechanisms from a range of disciplines, demonstrate that they are not yet impacting on programmes, and argue for their systematic inclusion in policy and research.MethodsWe identified potential mechanisms relevant to health inequalities and their amelioration from different disciplines and analysed six policy documents published between 1976 and 2010 using Bacchi’s ‘What’s the problem represented to be?’ framework for policy analysis.ResultsWe found substantial evidence of supra-individualistic and relational mechanisms relevant to health inequalities from sociology, history, biology, neuroscience, philosophy and psychology. Policy documents sometimes expressed these mechanisms in policy rhetoric but rarely in policy recommendations, which continue to focus on individual behaviour.DiscussionCurrent evidence points to the potential of systematically applying broader thinking about causal mechanisms, beyond individual choice and responsibility, to the design, implementation and evaluation of policies to reduce health inequalities. We provide a set of questions designed to enable critique of policy discussions and programmes to ensure that these wider mechanisms are considered.
Highlights
Current UK policies designed to reduce health inequalities through preventing non-communicable disease are based largely on an individualistic epistemology
We argue that the adoption of a dynamic, relational epistemology is fundamental to a fuller realization of causal mechanisms and for the design and implementation of more effective interventions to address health inequalities
We reviewed six key policy documents published by the UK government or the English Department of Health between 1976 and 201025,27,39–42 using Bacchi’s ‘What’s the problem represented to be?’ (WPR) framework for policy analysis (Table 1).[43,44]
Summary
We identified potential mechanisms relevant to health inequalities and their amelioration from different disciplines and analysed six policy documents published between 1976 and 2010 using Bacchi’s ‘What’s the problem represented to be?’ framework for policy analysis
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