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Reducing health inequalities remains a challenge for policy makers across the world. Beginning from Lewin's famous dictum that "there is nothing as practical as a good theory", this paper begins from an appreciative discussion of 'fundamental cause theory', emphasizing the elegance of its theoretical encapsulation of the challenge, the relevance of its critical focus for action, and its potential to support the practical mobilisation of knowledge in generating change. Moreover, it is argued that recent developments in the theory, provide an opportunity for further theoretical development focused more clearly on the concept of power (Dickie et al. 2015). A critical focus on power as the essential element in maintaining, increasing or reducing social and economic inequalities – including health inequalities – can both enhance the coherence of the theory, and also enhance the capacity to challenge the roots of health inequalities at different levels and scales. This paper provides an initial contribution by proposing a framework to help to identify the most important sources, forms and positions of power, as well as the social spaces in which they operate. Subsequent work could usefully test, elaborate and adapt this framework, or indeed ultimately replace it with something better, to help focus actions to reduce inequalities. [ABSTRACT FROM AUTHOR]

It is accepted that within Britain there are persistent and growing inequalities in mortality between groups of people as defined by their social class. This paper shows that similar persistent and growing inequalities prevail between groups of people defined by district of residence. Although there is some confusion between these two ways of grouping people -- there is a slight tendency for people of the same class to live in the same district. This paper reviews the geographical literature which may shed light on why inequalities in mortality are widening between districts in Britain. We present new data for a set of 293 unchanging districts by amalgamating published reports from the 1950s, 60s and 70s with individual post-coded mortality records from the 1980s and 90s, aggregated to the 293 districts using a Geographic Information System and Census data from 1971, 1981 and 1991 (including estimates of the residence of the 'missing million'). We find that a growing proportion of premature deaths in Britain can be attributed to some aspect of rising spatial inequalities. Changing geographical inequalities in health are not simply a passive reflection of social inequalities. To begin to investigate them, however, we first need to measure them properly. [ABSTRACT FROM AUTHOR]

This paper contributes to the development of theory and research on inequalities in health. Our central premise is that these are currently limited because they fail adequately to address the relationship between agency and structure, and that lay knowledge in the form of narrative has a significant contribution to make to this endeavour. The paper is divided into three sections. In the first section we briefly review the existing, largely quantitative research on inequalities in health. We then move on to consider some of the most significant critiques of this body of work highlighting three issues: the pursuit of overly simple unidimensional explanations within 'risk factor' epidemiology and the (probably inevitable) inability of this research tradition to encompass the full complexity of social processes; the failure to consider the social context of individual behaviour and, in particular, the possibility for, and determinants of, creative human agency; and, thirdly, the need for 'place' and 'time' (both historical and biographical) to be given greater theoretical prominence. In the final section of the paper the potential theoretical significance of 'place' and 'lay knowledge', and the relationship between these concepts, in inequalities research is explored. Here we suggest three developments as a necessary condition for a more adequate theoretical framework in this field. We consider first the need for the conceptualisation and measurement of 'place' within a historical context, as the location in which macro social structures impact on people's lives. Second, we argue for a re-conceptualisation of lay knowledge about everyday life in general and the nature and causes of health and illness in particular, as narratives which have embedded within them explanations for what people do and why -- and which, in turn, shape social action. Finally, we suggest that this narrative knowledge is also the medium through which people locate themselves with... [ABSTRACT FROM AUTHOR]

The paper investigates relationship between mortality and social class as measured by the Erikson-Goldthorpe schema, a validated measure of employment conditions, and compares this with differentials found using the Registrar General's social classes. Two cohorts of men aged 15/16-44 were drawn from the OPCS Longitudinal Study for 1971 and 1981. Mortality differences between social classes were estimated using deaths occurring between 1976 and 1980 in the first cohort and 1986 and 1989 in the second. The two classification were formally compared by means of the Relative Index of Dissimilarity and a likelihood-based statistic. Similar mortality differentials were found using both classifications in the two time periods. The Erikson-Goldthorpe schema showed a clear pattern of higher mortality in those groups without a career structure and with lower discretion over their work. The paper concludes that inequalities in health are seen when a validated social class schema based on employment conditions is used. The use of validated measures will make it possible for health differences to be more clearly interpreted in policy terms. [ABSTRACT FROM AUTHOR]

Discussion of the persistence of social class inequalities in health has led to greater interest being paid to differences between the classes in lay health beliefs. Recent work on lay health beliefs, however, has mainly viewed social class as a proxy for wider aspects of lifestyle and paid less attention to its occupational component. Part of this can be explained by its predominant focus on the health beliefs of women. This paper remedies this imbalance by focusing on male Glaswegians' perceptions of the health effects of their occupations. It shows that not only were respondents very aware of the influence their jobs had on their health but that they also took action to redress the balance, either by compensating for such effects or controlling their work environment to minimise their influence. Respondents' degree of commitment to their work also had a direct bearing on their coping styles. Although traditional occupational class measures were found to obscure much of how occupation influences health, unskilled and semi-skilled workers did suffer the greatest limitations in coping with the health effects of work. [ABSTRACT FROM AUTHOR]