Acting upon the macrosocial environment to improve health: A framework for intervention

Abstract

Societal health inequalities are ubiquitous. Today, across populations, substantial differences in health outcomes are found on every continent and in every country. Macrosocial factors within society cause the inequitable distribution of resources and provide more opportunity to some but less to others. These factors are large-scale determinants, such as health policy, taxation, or urbanization, which can be modified and improved. Experts no longer dispute the claim that the poor suffer disproportionately from stressful life events and have lower levels of self-determination and greater demands from work and family than their wealthier counterparts. Such taxing circumstances undoubtedly increase harmful exposures - whether they be smoking, drinking, poor diet, or lack of exercise - and, more often than not, are found in combination with a lack of access to health-promoting incentives. Unfavorable residential and occupational exposures can also contribute to such health inequalities. Thus, social stratification results in an uneven distribution of risk factors and health endpoints. © 2007 Springer Science+Business Media, LLC.