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.
Highlights
In many welfare states a high standard of living and a wellestablished social security system dominate
Social mechanisms operating at the micro level, leading from residence, say, in a deprived area (P1) over time t1– t2 to poor health (P2), and poor health leads to health inequalities relative to residence in a less derived area (M2)
We found 12 studies which mentioned social mechanisms but did not directly quantitatively assess their effects on health inequalities
Summary
In many welfare states a high standard of living and a wellestablished social security system dominate. In addition to individual socio-economic factors, there is growing evidence that mechanisms at small-area level ( known as neighborhood effects) play a role in the production of health inequalities (3–5). The small-area context (structures in the social and physical environment where individuals live) influencing health can contribute to health inequalities between areas (6). Understanding how small-area health inequalities (social environment affects health and contribute to inequalities between areas) are generated and the role of social mechanisms in this process may help defining interventions to reduce inequalities. 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
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
