Journal
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
Volume 19, Issue 14, Pages -Publisher
MDPI
DOI: 10.3390/ijerph19148384
Keywords
socioeconomic health inequalities; narrative literature review; theoretical models; systems thinking; complex whole-system approach
Funding
- Netherlands Organization for Health Research and Development (ZonMw), Den Haag, The Netherlands [531001314]
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Despite efforts to reduce socioeconomic health inequalities through policies and interventions, these inequalities remain persistent. This paper provides insights into the reasons behind this persistence and proposes theoretical perspectives for improved approaches. These include studying individual determinants of health-related behaviors, considering determinants at both individual and environmental levels, and developing and evaluating effective approaches through systems thinking and stakeholder participation.
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.
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