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The quest for causal understanding of inequalities in health: holy grail or chimera?

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BRADFORD HILL SEMINAR

Although socio-economic inequalities in health have almost certainly always existed, they have been identified as a uniquely contemporary problem. Data to demonstrate the importance, reach and scale of socio-economic inequalities in health is plentiful and we can characterise the nature of the relationship between socio-economic factors and health outcomes with relative ease. However, understanding the causal mechanisms that relate social phenomena with biological outcomes has proved more challenging, and several competing explanations exist. As a consequence, evidence to underpin specific interventions to reduce inequalities in health has also proved elusive. Nevertheless, observational evidence suggests that increasing access to financial and material resources should result in better health. We may question, therefore, whether we need to pursue causal understanding of inequalities in health – perhaps this is a distraction for both researchers (who might better focus on more soluble problems) and practitioners (who might better focus on implementing interventions that we know have the potential to improve health)? In this lecture I aim to explore this question and, in doing so, will provide historical context for the problem, shed light on the methodological challenges, and offer theoretical insights. The talk should have relevance for many disciplines.

This talk will be introduced by Professor Nick Wareham, director of the MRC Eidemiology Unit and CEDAR .

This talk is part of the Bradford Hill seminars at the Cambridge Institute of Public Health series.

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