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Ladders, pyramids and champagne: the iconography of health inequities.

Authors
  • Krieger, N
Type
Published Article
Journal
Journal of Epidemiology & Community Health
Publisher
BMJ
Publication Date
Dec 01, 2008
Volume
62
Issue
12
Pages
1098–1104
Identifiers
DOI: 10.1136/jech.2008.079061
PMID: 19008371
Source
Medline
License
Unknown

Abstract

Conceptual models are crucial for theorising, depicting and explaining population distributions of health inequities. This is because a visual conceptual model, like a map, can simultaneously organise and spur ideas and observations. Incorporating both imagery and metaphor, visual models not only illustrate key constructs and causal relationships specified by scientific theories but also provide an important tool for integrating and evaluating rapidly emerging findings and for guiding new research. It therefore is instructive to consider and contrast different sets of images appearing in the public health, policy and popular literature pertaining to (1) social stratification, (2) determinants of population health and (3) determinants of health inequities. At issue is how different types of images illuminate, or obscure, the relevant causal processes that need to be altered to improve population health and reduce health inequities. Of particular concern are conceptual confusions created when (a) models inaccurately depict the distribution of population and resources and (b) models of determinants of population health, rather than of determinants of health inequities, are used in discussions about social inequalities in health. Although perhaps a pragmatic argument can be made for use of less politically controversial imagery in policy-oriented documents, I would argue that the public's health will be better served by an iconoclastic iconography, one that clearly and unequivocally delineates the social facts of skewed distributions of power and resources and depicts the societal processes that generate and maintain these distributions and their embodiment in population levels and distributions of health, disease and well-being.

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