Scaling up: The politics of health and place

Research into the role of place in shaping inequalities in health has focused largely on examining individual and/or localised drivers, often using a context-composition framing. Whilst this body of work has advanced considerably our understanding of the effects of local environments on health, and...

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Bibliographic Details
Published in:Social science & medicine (1982) Vol. 232; pp. 36 - 42
Main Authors: Bambra, Clare, Smith, Katherine E., Pearce, Jamie
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.07.2019
Pergamon Press Inc
Subjects:
Case studies
Consciousness
Developed Countries
Geography
Health
Health Behavior
Health care expenditures
Health disparities
Health Policy
Health research
Health Services Research
Health Status Disparities
Humans
Inequality
Mortality
Mortality - trends
Place
Political economy
Politics
Residence Characteristics - statistics & numerical data
Socioeconomic Factors
Geography
Politics
Health
Place
Inequality
ISSN:0277-9536, 1873-5347, 1873-5347
Online Access:Get full text
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Summary:Research into the role of place in shaping inequalities in health has focused largely on examining individual and/or localised drivers, often using a context-composition framing. Whilst this body of work has advanced considerably our understanding of the effects of local environments on health, and re-established an awareness of the importance of place for health, it has done so at the expense of marginalising and minimising the influences of macro political and economic structures on both place and health. In this paper, we argue that: (i) we need to scale up our analysis, moving beyond merely analysing local horizontal drivers to take wider, vertical structural factors into account; and (ii) if we are serious about reducing place-based health inequalities, such analysis needs be overtly linked to appropriate policy levers. Drawing on three case studies (the US mortality disadvantage, Scotland's excess mortality, and regional health divides in England and Germany) we outline the theoretical and empirical value of taking a more political economy approach to understanding geographical inequalities in health. We conclude by outlining the implications for future research and for efforts to influence policy from ‘scaling up’ geographical research into health inequalities. •Health-place research commonly examines focuses individual and/or localised drivers.•Health geography should ‘scale up’ analysis of health-place relationships.•Research needs to account for wider, vertical and structural factors.•Political economic approaches add value to insight on geographic health inequalities.•Considers the policy implications of taking a political economy approach.
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ISSN:0277-9536
1873-5347
1873-5347
DOI:10.1016/j.socscimed.2019.04.036