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How and why do interventions that increase health overall widen inequalities within populations?
Abstract
The second major pathway through which social inequality affects public health is through the cumulative effects of advantage and disadvantage on broad population groups. This chapter presents a theoretical model for this, showing how in the presence of social inequalities, even interventions designed to improve health can widen health disparities between groups. For example, requiring cancer screening at medical examinations might be a laudable public health intervention, but in a society where not everyone is covered by health insurance, it tends to widen health disparities even as it improves overall health. The chapter also examines the inverse care law which states that ‘the availability of good medical care tends to vary inversely with the need for it in the population served’.
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“This can also be explained by the fact that public health interventions, when effective, have been shown to widen health inequalities (80).”
From Theoretical and practical challenges of proportionate universalism: a review (2020) · cites this paper as [80]
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What types of interventions generate inequalities? Evidence from systematic reviews
Lorenc, T., Petticrew, M., Welch, V., & Tugwell, P. (2013) · Journal of Epidemiology and Community Health · doi:10.1136/jech-2012-201257 · Cited by 927
Adams, J., Mytton, O., White, M., & Monsivais, P. (2016) · PLOS Medicine · doi:10.1371/journal.pmed.1001990 · Cited by 492
Self-citationGiles, E. L., Robalino, S., McColl, E., Sniehotta, F. F., & Adams, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090347 · Cited by 470
Self-citationMcGill, R., Anwar, E., Orton, L., Bromley, H., Lloyd-Williams, F., O’Flaherty, M., Taylor-Robinson, D., Guzman-Castillo, M., Gillespie, D., Moreira, P., et al. (2015) · BMC Public Health · doi:10.1186/s12889-015-1781-7 · Cited by 407
Self-citationBambra, C. (2011) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2011.136333 · Cited by 284
Liu, J., Davidson, E., Bhopal, R., White, M., Johnson, M., Netto, G., Deverill, M., & Sheikh, A. (2012) · Health Technology Assessment · doi:10.3310/hta16440 · Cited by 237
Self-citationHillier-Brown, F. C., Bambra, C. L., Cairns, J.-M., Kasim, A., Moore, H. J., & Summerbell, C. D. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-834 · Cited by 230
Socioeconomic Inequalities in Lung Cancer Treatment: Systematic Review and Meta-Analysis
Forrest, L. F., Adams, J., Wareham, H., Rubin, G., & White, M. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001376 · Cited by 220
Self-citationTheoretical and practical challenges of proportionate universalism: a review
Francis-Oliviero, F., Cambon, L., Wittwer, J., Marmot, M., & Alla, F. (2020) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2020.110 · Cited by 136
Brown, T., Smith, S., Bhopal, R., Kasim, A., & Summerbell, C. (2015) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph120100566 · Cited by 91
Pottie, K., Welch, V., Morton, R., Akl, E. A., Eslava-Schmalbach, J. H., Katikireddi, V., Singh, J., Moja, L., Lang, E., Magrini, N., et al. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.08.001 · Cited by 80
Trinh-Shevrin, C., Islam, N. S., Nadkarni, S., Park, R., & Kwon, S. C. (2015) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2015.0067 · Cited by 71
Penn, L., Dombrowski, S. U., Sniehotta, F. F., & White, M. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-002949 · Cited by 55
Self-citationMcNaughton, R. J., & Shucksmith, J. (2015) · Journal of Public Health · doi:10.1093/pubmed/fdu066 · Cited by 30
Nordheim, O., & van der Wel, K. A. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.117721 · Cited by 6
Metadata
- Authors
- White, M., Adams, J., & Heywood, P.
- ORCID
- White, Martin
- Venue
- Social inequality and public health
- Publisher
- Policy Press
- Published
- 2009-04-22
- Pages
- 64-81
- OpenAlex
- W2482465208
- Cited by
- 249
- References
- 0
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 9 · 2023: 15 · 2022: 13 · 2021: 16 · 2020: 36 · 2019: 16 · 2018: 11 · 2017: 14 · 2016: 20 · 2015: 22 · 2014: 21 · 2013: 20 · 2012: 4
- FWCI
- 26.20
- Type
- book chapter
- Language
- en
- Open access
- closed
- Locations
- Policy Press eBooks (publishedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
- Keywords
- health disparities, public health interventions, health insurance coverage, cancer screening, inverse care law, social inequality
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