How could differences in 'control over destiny' lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment

Margaret Whitehead, Andy Pennington, Lois Orton, Shilpa Nayak, Mark Petticrew, Amanda Sowden, Martin White

Research output: Contribution to journalArticlepeer-review


We conducted the first synthesis of theories on causal associations and pathways connecting degree of control in the living environment to socio-economic inequalities in health-related outcomes. We identified the main theories about how differences in 'control over destiny' could lead to socio-economic inequalities in health, and conceptualised these at three distinct explanatory levels: micro/personal; meso/community; and macro/societal. These levels are interrelated but have rarely been considered together in the disparate literatures in which they are located. This synthesis of theories provides new conceptual frameworks to contribute to the design and conduct of theory-led evaluations of actions to tackle inequalities in health.

Original languageEnglish
Pages (from-to)51-61
Number of pages11
JournalHealth and Place
Early online date14 Mar 2016
Publication statusPublished - 1 May 2016

Bibliographical note

© 2016, The Authors.


  • Causal theory
  • Control over decisions
  • Health inequalities
  • Living environment
  • Social determinants of health
  • Social Determinants of Health
  • Health Status Disparities
  • Humans
  • Environment
  • Social Class

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