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Health Place. 2016 May;39:51-61. doi: 10.1016/j.healthplace.2016.02.002. Epub 2016 Mar 14.

How could differences in 'control over destiny' lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment.

Author information

1
Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool L69 3GB, United Kingdom. Electronic address: mmw@liverpool.ac.uk.
2
Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool L69 3GB, United Kingdom. Electronic address: ajpenn@liverpool.ac.uk.
3
Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool L69 3GB, United Kingdom. Electronic address: lorton@liverpool.ac.uk.
4
Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool L69 3GB, United Kingdom. Electronic address: shilpan@liverpool.ac.uk.
5
Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom. Electronic address: Mark.Petticrew@lshtm.ac.uk.
6
Centre for Reviews and Dissemination, University of York, Heslington, York YO10 5DD, United Kingdom. Electronic address: amanda.sowden@york.ac.uk.
7
UKCRC Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom. Electronic address: Martin.White@mrc-epid.cam.ac.uk.

Abstract

We conducted the first synthesis of theories on causal associations and pathways connecting degree of control in the living environment to socio-economic inequalities in health-related outcomes. We identified the main theories about how differences in 'control over destiny' could lead to socio-economic inequalities in health, and conceptualised these at three distinct explanatory levels: micro/personal; meso/community; and macro/societal. These levels are interrelated but have rarely been considered together in the disparate literatures in which they are located. This synthesis of theories provides new conceptual frameworks to contribute to the design and conduct of theory-led evaluations of actions to tackle inequalities in health.

KEYWORDS:

Causal theory; Control over decisions; Health inequalities; Living environment; Social determinants of health

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