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Social determinants of health and health inequalities
Most health differences between population groups arise from the conditions in which people are born, grow, work and age – education, income, employment, housing and environment – so there is a social gradient: at every step of the socioeconomic ladder health is better than at the step below.
Why it matters in the exam
Items on this topic ask what is true about health inequalities: that they appear as a continuous gradient and not only as a gap between the poor and everyone else, that inequality is any difference whereas inequity is a difference that is avoidable and unjust, and that access to medical services explains only part of the gaps. Models are tested: the Dahlgren and Whitehead "rainbow" model, with layers of factors from individual factors up to general socioeconomic conditions; the framework of the World Health Organization commission on social determinants (2008); the "inverse care law" – the availability of good care varies inversely with need; and "proportionate universalism" – a service for everyone with an intensity that grows with need. Other items ask you to choose the intervention that promotes equity most effectively – usually structural policy such as early childhood education, taxation or better housing, not an information campaign that reaches mainly the educated and may widen the gap. In Israel, gaps in life expectancy, infant mortality and chronic disease between Arabs and Jews, between periphery and centre and between income groups are tested, as is the role of health literacy – the ability to obtain, understand and use health information.
Key points
- The conditions in which people live and work determine most health gaps.
- Health inequality appears as a continuous social gradient.
- The inverse care law: the availability of good care runs opposite to need.
- Proportionate universalism matches the intensity of a service to need.
- Structural policy narrows gaps more than information alone.
Summary table
| Concept | Meaning | Example |
|---|---|---|
| Social gradient | Health improves step by step with each rise on the social ladder | The Whitehall studies of British civil servants |
| Inequity | A difference that is avoidable and unjust | A gap in infant mortality between localities |
| Inverse care law | Availability of good care is inversely related to need | Fewer specialists in the periphery |
| Proportionate universalism | A service for everyone, with intensity growing with need | Extra resources for maternal and child centres in deprived areas |
| Rainbow model | Individual factors, lifestyle, community, living and working conditions, general policy | Used to map points of intervention |
| Health literacy | The ability to obtain, understand and use health information | Explanatory materials in plain language and several languages |
A free exam question
איזה רישיונות צריך להסדיר עסק של ?קייטרינג (the question as examined, in Hebrew)
- א. רישיון עסק בלבד
- ב. רישיון יצור בלבד
- ג. רישיון עסק ורישיון יצור
- ד. רישיון עסק ואישור כיבוי אש
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Sources
- WHO Commission on Social Determinants of Health, Closing the gap in a generation, 2008 — Conceptual framework and recommendations
- Marmot, Fair Society, Healthy Lives (The Marmot Review), 2010 — Proportionate universalism
- Dahlgren & Whitehead, Policies and strategies to promote social equity in health, 1991 — The main determinants of health
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.