title: Inequalities in health: definitions, concepts, and theories.
abstract: Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose-response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Arcaya
authors.affiliation: Region 2, United States Environmental Protection Agency, New York, NY, USA.
authors.forename: Alyssa L
authors.initials: AL
authors.lastname: Arcaya
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA; svsubram@hsph.harvard.edu.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D004777:Environment; D014943:Global Health; D015438:Health Behavior; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D012111:Residence Characteristics; D066270:Social Capital; D012959:Socioeconomic Factors
keywords: health disparities; inequality; inequity; theory