Levelling up: Global examples of reducing health inequalities

Abstract

There are significant inequalities in health by socio-economic status, race/ethnicity, gender, neighbourhood deprivation and other axes of social inequality. Reducing these health inequalities and improving health equity is arguably the ‘holy grail’ of public health. This article engages with this quest by presenting and analysing historical examples of when sizeable population-level reductions in health inequalities have been achieved. Five global examples are presented ranging from the 1950s to the 2000s: the Nordic social democratic welfare states from the 1950s to the 1970s; the Civil Rights Acts and War on Poverty in 1960s USA; democratisation in Brazil in the 1980s; German reunification in the 1990s; and the English health inequalities strategy in the 2000s. Welfare state expansion, improved health care access, and enhanced political incorporation are identified as three commonly held ‘levellers’ whereby health inequalities can be reduced – at scale. The article concludes by arguing that ‘levelling up’ population health through reducing health inequalities requires the long-term enactment of macro-level policies that aggressively target the social determinants of health.