The health inequalities impact of low control in the living environment: a theory-led systematic review of observational studies

Orton, L, Pennington, A ORCID: 0000-0002-3455-8825, Nayak, S, Whitehead, M ORCID: 0000-0001-5614-6576, Petticrew, M, White, M and Sowden, A (2014) The health inequalities impact of low control in the living environment: a theory-led systematic review of observational studies. European Journal of Public Health, 24 (suppl_).

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Abstract

Background Scientific debate has considered whether ‘control over destiny’ could be a fundamental social determinant of health (and a lack thereof, an underlying cause of health inequalities). We identified plausible theoretical pathways from control in the living environment to health inequalities at the micro-, meso- and macro-levels, and conducted a systematic review of the empirical evidence for these hypothesised pathways. Results for the micro-level are presented here. Methods Studies were identified by searching seven bibliographic databases, screening reference lists, consulting key informants and searching organisational websites. Observational studies of any design were included. Screening, data extraction and quality appraisal were carried out by two reviewers, with disagreements brought to the wider team. Analysis incorporated narrative synthesis. Results We identified 5 high quality prospective cohort studies in the UK and The Netherlands, and a further 19 studies of weaker design. Observational evidence from cohort studies suggests that low control at home may explain part of the association between household social position and coronary heart disease among women (but not men), possibly due to lack of material and psychosocial resources to cope with excessive household and family demands. This supports the theory that demand overload, coupled with lower control and fewer resources, is more prevalent with lower social position, and these factors interact leading to chronic stress and poorer health. Evidence also suggests that lower social positions are associated with both a) lower control beliefs; and b) poorer health outcomes; and that a substantial proportion of the association between low social position and health outcomes (heart disease, mortality) may be explained statistically by low control beliefs. The studies were not able to distinguish between the effects of having low control beliefs and actual experience of low control over essential resources, which have different implications for policy. Conclusions Observational evidence supports some of the theoretical pathways connecting the experience of low social position with poorer health via low control. There is a need for evidence on the impacts of actions to intervene in these pathways. Key messages Low control experienced in the day-to-day lives of people in lower social positions may play a role in determining the social gradient in health. Further high-quality empirical studies are needed to tease out the most important pathways leading from low control to health inequalities, to inform future public health strategy.

Item Type:	Article
Uncontrolled Keywords:	10 Reduced Inequalities
Depositing User:	Symplectic Admin
Date Deposited:	03 Aug 2015 16:16
Last Modified:	15 Mar 2024 13:20
DOI:	10.1093/eurpub/cku162.069
Related URLs:	Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/2018582