Inequalities in health: Contested explanations, shifting discourses and ambiguous policies

Abstract

The research field of health inequalities is unavoidably politicized: through the ideological context in which such research is conducted, through the explanatory frameworks advanced, and through the linked discourses that propose or imply particular solutions to the problem. After years of official neglect, reducing inequalities in health is now an established part of UK Government policy. However, the research evidence has become increasingly complex in past decades and a number of different explanatory discourses have developed. This discussion paper presents a brief overview of three identifiable but contested explanations (poverty/deprivation; psychosocial stress; individual deficit) and adopts an existing discourse model (Levitas's RED, MUD and SID) to conceptualize the links between such explanations and potential policy solutions. A 'political' model of the research-policy relationship is used to suggest that the uncertainty surrounding competing explanations and solutions to the problem of health inequalities enables flexibility of interpretation and political manoeuvring at the policy-making level. The capacity for shifts in discourse enables the UK Government to claim leadership in tackling the issue whilst simultaneously assigning responsibility for action to the community and individual level.

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