Introductory sentence: The debate about health equity inevitably leads to questions of social inequalities. The term "social inequalities" refers to the unequal distribution of resources, opportunities in life and options to act in society. Health inequalities pertain to the unequal distribution of health-related resources and, correspondingly, the chances to use them, manifesting themselves in differing health-related behaviour and health status.
To gain a realistic picture of social inequality and its impact on health in Switzerland, the following traits of inequality ought to be considered: (school) education, occupation and employment, income and wealth, social background, sex (see also separate entry), age and migration background (see also separate entry). These factors may all contribute to inequality and have an effect on our capacity to act; yet, they rarely influence health directly. Higher income, for instance, does not automatically make for a healthier person. In fact, inequality affects life style and health in complex ways. Of particular importance is the correlation between various inequality traits and specific social and living conditions: these go hand in hand with differing health options and choices. This correlation may have conflicting consequences - the potentially positive health effects of an interesting and well paid job, for example, may very well be nullified by long working hours and stress in the workplace.
For health promotion and prevention this means two things:
- Just pointing to a target group's low education or low income is not sufficient. Rather, it may help to show why and how these factors, in interaction with other inequalities, restrain or improve health-related actions.
- Looking at inequality reinforces one of health promotion’s main concerns: to not just fight against the symptoms of health inequalities but also to work towards establishing health equity. This goal also implies measures at the level of general social inequalities. It means that efforts to improve the "general population’s education" or income support for disadvantaged groups contribute significantly to the promotion of health.
Why you would disregard these aspects
- The topic "Health Equity" seems irrelevant for your project. Your assumption is that there are other more important factors to consider.
- You are sure this topic is sufficiently accounted for, since your project addresses all individuals.
- The topic appears too complicated; you do not believe to be adequately qualified to deal with the issue.
- You fear to get on the wrong side of your project commissioner and financer, because inequality is a sensitive subject.
What you have to gain
- Your project may be better embedded into the general social context and you may find it easier to identify the project’s potentialities and limitations.
- You gain additional insight into the resources and possibilities of your target group as well as into the complex interdependencies in your project.
- You run less risk of walking into the trap of well intentioned measures which may not be understood by your target group. You are sensitive to possible comprehension problems and conflicts between the project team and target groups.
- Your project will be more closely associated with the creation of health equity which stands high on the health promotion agenda. At best, you are not only contributing to the reduction of health inequalities but also to the reduction of social inequalities in general.
What you can actually do
- Dedicate half a day to the themes of social inequality and equity and discuss them in detail with the team.
- Take the corresponding working paper "Social inequality and health". It contains questions and challenges relating to the inequality issue and how to address it.
- Think about the different socio-economic and socio-demographic characteristics of specific target groups – but also the characteristics of the project team. Mark the different positions on the inequality chart, thus creating a visual image of the differences, if any. From this basis, you can derive potential disadvantages as well as opportunities and resources of the different target groups.
Questions for critical reflection
- Do you know the socio-economic and socio-demographic characteristics of your target groups and are you aware of the consequences this has for the accessibility of these groups?
- Have you thought about the particular resources related to each groups’ characteristics and how you could make use of them?
- Look at the dimensions where the project team’s characteristics differ from each target group. Do these differences, if any, have consequences for your project?