Health inequalities, fundamental causes and power: towards the practice of good theory
Open accessAbstract
Reducing health inequalities remains a challenge for policy makers across the world. Beginning from Lewin’s famous dictum that “there is nothing as practical as a good theory”, this paper begins from an appreciative discussion of ‘fundamental cause theory’, emphasizing the elegance of its theoretical encapsulation of the challenge, the relevance of its critical focus for action, and its potential to support the practical mobilisation of knowledge in generating change. Moreover, it is argued that recent developments in the theory, provide an opportunity for further theoretical development focused more clearly on the concept of power (Dickie et al. 2015). A critical focus on power as the essential element in maintaining, increasing or reducing social and economic inequalities – including health inequalities – can both enhance the coherence of the theory, and also enhance the capacity to challenge the roots of health inequalities at different levels and scales. This paper provides an initial contribution by proposing a framework to help to identify the most important sources, forms and positions of power, as well as the social spaces in which they operate. Subsequent work could usefully test, elaborate and adapt this framework, or indeed ultimately replace it with something better, to help focus actions to reduce inequalities.
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Various power mechanisms, including economic and knowledge-based ones, serve as channels for power inequity.
“Various power mechanisms, including economic and knowledge-based ones, serve as channels for power inequity (6).”
From Bridging Sectors and Disciplines to Gain a Critical Understanding of the Eco-Social Determinants of Health Inequities: The ESDHI-EU Conference (2025) · cites this paper as [6]
Health inequities manifest broader systems of inequity shaped by sociopolitical power dynamics that systematically benefit elite groups over others.
“In this regard, health inequities manifest broader systems of inequity shaped by sociopolitical power dynamics that systematically benefit elite groups over others.”
From Bridging Sectors and Disciplines to Gain a Critical Understanding of the Eco-Social Determinants of Health Inequities: The ESDHI-EU Conference (2025) · cites this paper as [6]
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Self-citation
- Authors
- McCartney, G., Dickie, E., Escobar, O., & Collins, C.
- Affiliations
- Public Health Scotland (GB)
- University of Edinburgh (GB)
- University of the Faroe Islands (FO)
- Corresponding author
- McCartney, Gerry
- Venue
- Sociology of Health & Illness
- Publisher
- Wiley
- Published
- 2020-11-22
- Volume
- 43
- Issue
- 1
- Pages
- 20-39
- ISSN
- 0141-9889 (ISSN-L)
- 1467-9566
- PMC
- PMC7894306
- OpenAlex
- W3107066117
- Cited by
- 110
- References
- 108
- Citations by year
- 2026: 14 · 2025: 28 · 2024: 21 · 2023: 20 · 2022: 21 · 2021: 5 · 2020: 1
- FWCI
- 6.51
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Sociology of Health & Illness (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc)
- Funders
- Economic and Social Research Council (ES/M003922/1)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
- Keywords
- health disparities, fundamental cause theory, power, social determinants of health, social inequality, economic inequality, health policy, knowledge mobilization
- MeSH terms
- Humans, Socioeconomic Factors, Health Status Disparities
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