The differences and similarities between two traditional approaches to health equity and inequalities are analysed in a new report for the World Health Organisation.
Health inequalities in early mortality and patterns of illness within and between countries remain a major problem and are a significant global social injustice. This is despite the extensive literature and scientific evidence from the two different approaches, both approaches proposing various solutions.
The report distinguishes between individually oriented behaviour change interventions to improve health and interventions to improve health by tackling the social or wider determinants of health. It proposes ‘scientific consilience’ or the integration of the two approaches, in order to support local, national and international policy makers, practitioners and politicians to address health inequalities.
Commissioned by the World Health Organisation, the report was written by a University of Cambridge research team from the Department of Public Health and Primary Care and Cambridge Public Health. It is based on a review of reviews of the behavioural interventions literature and the wider determinants literature, as well as a narrative review of other relevant materials.
The authors, led by Professor Mike Kelly, make the case for finding connections between the two approaches and outline the practical implications of integrating the evidence across both approaches.
Case-studies about tobacco control, HIV prevention and control, the response to COVID-19 in the United Kingdom, and obesity are used to illustrate examples of consilience and non-consilience, the use of evidence from outside the peer-reviewed literature, and how consilience might work in practice.
Professor Kelly said: “Our review found that consilience is well developed in tobacco control and HIV prevention and control, but much less so for other complex health challenged like obesity. We suggest that a shift in thinking is required to allow real interdisciplinary work to occur. It is important for researchers and policy- and decision-makers to move beyond single disciplinary paradigms to see the problems of, and solutions to, health inequalities in their entirety”.
Read the report
Michael P Kelly, Ananya Arora, Anjuli Banerjee, Jack M Birch, Nnenna Ekeke, Isla Kuhn et al: The contribution of behavioural science to addressing the social and wider determinants of health: evidence review. World Health Organisation 2023. ISBN 978-92-4-007247-3 (electronic version)
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