The causes of good health go far beyond quality of healthcare. They include a range of socio-economic factors which are interlinked. Research lays bare the causes and manifestations of inequalities, and needs of vulnerable groups . By identifying policy priorities and examining what works, it informs policies and practices that address the determinants of health.
An overview of the most notable research publications and data surveys in the field of health inequalities is provided below. More outputs and data sources are available in our resource database.
Below are some recent publications on health equity. Click on the link to find more information about the publication in our database.
- Healthy, prosperous lives for all: the European Health Equity Status Report (2019)
- Health Inequalities: Persistence and Change in European Welfare States. By Johan Mackenbach (2019)
- The Unequal Pandemic: COVID-19 and Health Inequalities. By Clare Bambra, Julia Lynch and Katherine E. Smith (upcoming, June 2021)
- The Health Gap: the challenge of an unequal world. By Michael Marmot, 2015
CHAIN – The Centre for Global Health Inequalities Research
CHAIN is a leading centre and interdisciplinary research network for global health inequalities. The centre is based at the Norwegian University of Science and Technology (NTNU). It brings together expert researchers in the field of health, social determinants, civil society and the UN system. Its aim is to advance health inequalities research, particularly on child health, and reduce the distance between research, policy and practice.
CHAIN's partners include some of the most influential scholars at universities around the world, the Norwegian Institute of Public Health, the International Agency for Research on Cancer, EuroHealthNet and UNICEF. CHAIN was built on the assumption that efforts to reduce inequalities in health will continue to fail unless and until the contribution of low socio-economic position as a global determinant of morbidity and early mortality is clarified. Effective and evidence-based policies and practices to address the social determinants of health are essential to increase health equity around the world. CHAIN engages with policymakers and practitioners in the field of public health, environmental, social and corporate policy.
Journals publishing on health inequalities
- BMC Public Health (Link)
- BMJ (Link)
- European Journal of Public Health (Link)
- Health Policy (Link)
- International Journal on Environmental Research and Public Health (Link)
- JAMA series (particularly JAMA open) (Link)
- Journal for Equity in Health (Link)
- Journal of Health and Social Behaviour (Link)
- Journal of Health Monitoring - Robert Koch Institute (Link)
- Lancet (Link)
- Public Health (Link)
- Scandinavian Journal of Public Health (Link)
- Social Issues and Policy Review: (Link)
- POLS Public Health - (Link)
The main determinants of health
The most widely used model to explain health inequalities is the Dahlgren-Whitehead ‘Rainbow model’. The model maps the relationship between the individual, their environment and health, also called the determinants of health. At the centre of the model is the individual who possesses individual, and often fixed, characteristic such as their age, sex and constitutional characteristics. The individual is surrounded by the various spheres that impact health and that are theoretically modifiable by policy. These include individual lifestyle factors, community influences, and living and working conditions.
The Rainbow model emphasises interactions: individual lifestyles are embedded in social norms and networks, and in living and working conditions. These in turn are related to the wider socioeconomic and cultural environment.
The determinants of health that can be influenced by individual, commercial or political decisions can be positive health factors, protective factors, as well as risk factors
The Marmot reviews
The ‘Marmot Reviews’ refer to the work that is carried out by Professor Sir Michael Marmot and his team at University College London (UCL). In 2008, Professor Sir Michael Marmot chaired an independent review of health inequalities in England. Besides assessing the situation, the review proposed the most effective evidence-based strategies for reducing health inequalities in England. All reports are available here.
#Marmot2020: The Marmot Review 10 Years On
In 2020, a new Marmot review, called The Marmot Review 10 years on, came out. The report assessed the state of health inequalities in England and the progress that was made over the last decade. The report found that health inequalities had increased and that the social gradient had become steeper over the previous decade. There were big differences in life expectancy between regions in England, and homelessness and child poverty had considerably increased.
The WHO Regional Office for Europe commissioned a review of social determinants of health and the health divide. This review was executed by a group of experts led by Sir Michael Marmot. Its aim was to set out the health divide and inequalities in health in Europe. The review fed into the development of the WHO Europe’s Health 2020 strategy. A key goal of the review was to identify what works and how to implement good practices across the diverse context of the European Region.
The final report of the review was published in 2013. The review had identified key areas for action and the guidelines and good practices. The report set out new approaches towards reducing health gaps between and within European countries. These were complemented with guidelines for policies in each of the key areas for action. In addition, the report also urged countries to implement policies to mitigate the negative impact of social determinants of health. It showed that even small actions in these areas can improve health equity. It highlighted that, besides the moral argument for action, reducing health inequalities also makes economic sense.
The Spirit Level: Why More Equal Societies Almost Always Do Better
The Spirit Level: Why More Equal Societies Almost Always Do Better was published in 2009. Written by Kate Pickett and Richard Wilkinson, the book highlights the "pernicious effects that inequality has on societies: eroding trust, increasing anxiety and illness, (and) encouraging excessive consumption". It shows that for the outcomes of different health and social problems are significantly worse in more unequal rich countries.
Find more information about this book in our database.
Understanding Health Inequalities
The book Understanding Health Inequalities provides an accessible and engaging exploration of why the opportunity to live a long and healthy life remains profoundly unequal. The authors outline the enduring link between people’s socioeconomic circumstances and their health and tackle questions at the forefront of research and policy on health inequalities.
Find more information in our database.
Health Inequality: An Introduction to Concepts, Theories and Methods
By examining influences of social class, income, culture and wealth as well as gender, ethnicity and other factors in identity, this accessible book provides a key to understanding of the causes of inequality in health.
Evaluating the evidence of health outcomes over time and at local and national levels, the author Mel Bartley argues that individual social integration demands closer attention if health inequality is to be tackled effectively.
Find more information in our database..
International surveys and data on health equity
The WHO Health Equity Monitor
Hosted on the WHO’s World Health Data Platform, the Health Equity Monitor provides evidence on existing health inequalities and makes available tools and resources for health inequality monitoring and research. It includes:
- The Health Equity Monitor Database, a large database of disaggregated data. It currently includes data for more than 30 reproductive, maternal, newborn and child health indicators, disaggregated by six dimensions of inequality, from over 450 international household health surveys conducted in 115 countries in 1991-2018.
- Interactive data visualizations, that present data from the Health Equity Monitor database in an interactive way.
- The Health Equity Assessment Toolkit (HEAT), a software application for assessing health inequalities in countries.
- Publications, including handbooks, manuals, advocacy booklets and reports.
The World Health Database Platform hosts a range of other key data tools, data sets and databases related to global health and wellbeing as well. Most notably, the Global Health Observatory data repository holds data on health-related statistics for the 194 WHO Member States. It provides access to over 1000 indicators on, among other topics, mortality and morbidity, the SDGs, health systems, environmental health and health equity.
Find all WHO data collections here.
Eurostat is the statistical office of the European Union. Its main aim is to provide statistical information to EU institutions and to promote the harmonisation of statistical methods. Eurostat statistics are publicly and freely available. Its database includes indicators from all parts of society, including health, labour, industry, environment and migration.
EU Statistics on Income and Living conditions (EU-SILC)
Eurostat’s dataset on income and living conditions offers statistics on many of the socioeconomic determinants of health. Indicators include income, poverty, social exclusion, housing, labour, education and health. The data is compiled using the EU-Statistics on Income and Living Conditions (EU-SILC) instrument. By collecting timely and comparable cross-sectional and longitudinal multidimensional microdata on income, social exclusion and living conditions to, EU-SILC aims to produce structural indicators of social cohesion and social inclusion in the EU.
Other Eurostat datasets relevant for health inequalities are
- Health, including data on morbidity and mortality, health care and health determinants;
- Quality of life, including indicators on material living conditions, education and health;
- Education, which, among others, includes data on participation in education for children and adults;
- Social protection. This dataset includes indicators on pensions, social benefits, and expenditure on healthcare;
- Equality on age, gender and disability; and
- Labour Market with indicators on unemployment, the gender pay gap, minimum wage, and quality of employment.
Eurofound is the European Foundation for the Improvement of Living and Working Conditions. It aims to assist in the development of better social, employment and work-related policies in Europe.
Eurofound has three regularly repeated pan-European surveys that offer a unique source of comparative information on the quality of living and working conditions across the EU. These surveys are:
- The European Company Survey;
- The European Quality of Life Survey
- The European Working Conditions Survey
The Organisation for Economic Co-operation and Development (OECD) offers data on topics ranging from economic projections to health, jobs, and social protection. All this data is collected in the OECD.Stat database.
In the OECD iLibrary, visitors find books, papers and statistics. The statistics section of the iLibrary offers databases, data warehouses, data on specific indicators, country statistical profiles, and statistical series.
Some of the most relevant OECD data resources for health equity are:
- Health statistics, which offers comparable statistics on health and health systems across OECD countries. Every two years this data is used to write the Health at a Glance report.
- The OECD Gender Data Portal, with indicators on education, employment, health and many more.
- Education statistics, which offers statistics on education systems, economic and social outcomes of education and training, but also the human and financial resources invested in education systems. Findings on education are summarised in the biannual Education at a Glance report.
- Employment and labour statistics, where data is broken down by sex and age, and users find statistics about part-time work, unemployment duration, and minimum wages.
- Social and welfare statistics, with indicators on social expenditure and benefits.
The European Social Survey
The biennial European Social Survey (ESS) maps and collects data on the attitudes, beliefs, and behaviour patterns of people in Europe. In 2014, the ESS first added a series of questions (module) about the social determinants of health to the survey. Because of the new module, which was proposed by CHAIN, the survey now allows for the evaluation of health inequalities in Europe.
The 2020 round of the ESS will form a key data source for the evaluation of the social, economic and health-related consequences of the COVID-19 pandemic, in addition to numerous other structural inequalities.
Data generated by the European Social Survey is freely available here.
The Global Burden of Disease
The Global Burden of Disease (GBD) study offers a comprehensive picture of what disables and kills people across countries, time, age and sex. Led by the Institute for Health Metrics and Evaluation (IMHE), the GBD provides a tool to quantify health loss from hundreds of diseases, injuries and risk factors. This data helps policymakers understand the nature of their country’s health challenges and to compare the effects of different diseases.
The GBD includes data on education and income, allowing for the visualisation of health inequalities. Additional determinants and indicators will be added to the tool in future releases.
EIGE Gender Statistics Database
EIGE is the European Institute for Gender Equality. In its Gender Statistics Database one finds statistics on the national and European level that. The database includes a wide range of indicators, including on health, work and labour conditions, education, and living conditions. Based on these statistics, EIGE publishes a yearly Gender Equality Index that measures the complex concept of gender equality and that helps monitor progress in gender equality.
The EuroHealthNet Research Platform
The EuroHealthNet Research Platform identifies and promotes evidence-based approaches to health, health equity and wellbeing. It works on a range of European and international projects, often led by the EuroHealthNet office. EuroHealthNet has a wide network of public health institutions, governmental institutions and researchers. It is through this network that EuroHealthNet helps insert evidence into the development of policies and practices that affect public health, health equity and the social determinants of health.
To maximise the impact of the projects it works on, the research platform works with researchers as well as decision-makers. Besides supporting and enabling research cooperation, it aims to provide an evidence base for policies and practices that tackle health inequalities and environmental threats to health. To find out more about the work of the platform and about being part of the platform visit our website.