Theoretical and practical challenges of proportionate universalism: a review

Florence Francis-Oliviero · Linda Cambon · Jérôme Wittwer · Michael Gideon Marmot · François Alla

108 citations0/0 files storedRevista Panamericana de Salud Pública

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Public Health and Social Inequalities Public Health Policies and Education Health disparities and outcomes

Abstract

OBJECTIVE: In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it.The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues. METHODS: of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases. RESULTS: This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs. CONCLUSION: This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.

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References

2005Scoping studies: towards a methodological framework 2010Scoping studies: advancing the methodology 2005Social determinants of health inequalities 2014Scoping reviews: time for clarity in definition, methods, and reporting 1998The Paradox of Redistribution and Strategies of Equality: Welfare State Institutions, Inequality, and Poverty in the Western Countries 2016Taking action on the social determinants of health in clinical practice: a framework for health professionals 2012What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review 2018Screening for social determinants of health in clinical care: moving from the margins to the mainstream

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