Space and Global Health/Equity in Health Care/Mechanisms of Health Inequity

Mechanisms of Inequities

Type 1 (Situational) Mechanism

Social mechanisms operating at macro-level could influence behavior of individual actors thus shaping certain forms of mechanistic interaction driving macro– micro changes. The various household or individual level effects in a given context due to larger institutional drivers is one way of viewing situational mechanisms.

Type 2 (Action- formulation) mechanism

This mechanism operate across individuals, within communities or households and draw upon individual agency. Intra-household interactions typically fall in this domain and are driven by individual desires, beliefs and opportunities. Intra-household healthcare decision-making, resource allocation and prioritization of problems within health or between health and competing interests such as child’s education or elderly care for example are driven by such mechanisms. Individual psycho-social practices shaped by cultural norms are also typically situated in this mechanism.

Type 3 (transformational) mechanism

here we see how individual action within and between people could be transformed into an intended or unintended collective outcome (micro–macro). These are typically scenarios when emancipatory action occurs through inter-individual interaction resulting in a transformative action at a higher level, typically at organizational or societal levels. Questioning and/or striving to change well-established social structures, norms and practices through people coming together is an example.

The CSDH framework

Commission on Social Determinants of Health (CSDH) findings on health inequities research:

• toxic combination of bad policies, economics and politics explain bad health in the world
• slope linking income and health is the social gradient
• health system will not naturally gravitate towards equity- there is a need for leadership, government policies and frame work
• wealth not sufficient for improving health – there is a need for equitable distribution
• much of the work to redress health inequities lies beyond the health sector