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

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


Publication details

JournalHealth and Place
DateAccepted/In press - 8 Feb 2016
DateE-pub ahead of print - 14 Mar 2016
DatePublished (current) - 1 May 2016
Number of pages11
Pages (from-to)51-61
Early online date14/03/16
Original languageEnglish


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.

Bibliographical note

© 2016, The Authors.

    Research areas

  • 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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