Causal mediation approaches for understanding pathways to inequalities and policy entry points: examples from early years health and development

Pearce, Anna, Hope, Steven, Green, Michael J, Lynch, John W, Oude Groeniger, Joost, De Stavola, Bianca, Viner, Russell M, Schluter, Daniela K and Taylor-Robinson, David ORCID: 0000-0002-5828-7724 (2026) Causal mediation approaches for understanding pathways to inequalities and policy entry points: examples from early years health and development JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 80 (2). pp. 105-113. ISSN 0143-005X, 1470-2738

Access the full-text of this item by clicking on the Open Access link.

Abstract

The reduction of health inequalities has been a priority of researchers, decision-makers and practitioners for many years. Advances in causal mediation analysis offer great promise for identifying intervention targets and inferring how policy actions might alter health inequalities. However, these methods are sometimes presented in a manner that is not accessible to the wider community of health researchers. Causal mediation methods also have a range of limitations and assumptions that have implications for their application and the interpretation of results. In this paper, we consider three types of questions that can be used to guide policy actions to reduce health inequalities, addressed using causal mediation methods: (1) which mediating pathways offer most promise for the reduction of health inequalities and should be the focus of further, more indepth analysis? 2) In the face of two competing pathways, which one is most likely to lead to a narrowing of health inequalities? 3) What would be the impact of a hypothetical intervention on one specific mediating pathway when implemented under different scenarios? Focusing on early years’ health, we use real life examples of the application of causal mediation methods to address these three types of question. In doing so, we discuss the relative strengths and limitations of these methods and introduce key mediation concepts relevant to health inequalities researchers.

Item Type:	Article
Uncontrolled Keywords:	METHODS, POLICY, COHORT STUDIES, Life course epidemiology, LONGITUDINAL STUDIES
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health Faculty of Health & Life Sciences > Inst. Population Health > Public Health, Policy & Systems Faculty of Health & Life Sciences > Inst. Population Health > Inst. Population Health (T&R Staff)
Depositing User:	Symplectic Admin
Date Deposited:	06 Nov 2025 09:26
Last Modified:	23 May 2026 10:42
DOI:	10.1136/jech-2025-224260
Open Access URL:	https://jech.bmj.com/content/early/2025/11/03/jech...
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3195250
Disclaimer:	The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate.