Falling down the rabbit hole? Methodological, conceptual and policy issues in current health inequalities research

Michelle Kelly-Irving* (Corresponding Author), William Ball, Clare Bambra, Cyrille Delpierre, Ruth Dundas, Julia Lynch, Gerry McCartney, Katherine Smith

*Corresponding author for this work

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Persistent health inequalities pose a challenge to researchers and policymakers. Decades of research have illuminated mechanisms that underlie health inequalities, now we must move beyond these observations to enable policies that can reduce them. In this paper, we highlight tensions in the field of health inequalities research regarding the relationship between social determinants and health outcomes, and the effectiveness of welfare policies. We draw on recent evidence to analyse and discuss these areas of debate and provide insight into the evidence on causality, welfare systems and policies aiming to address the social determinants of health inequalities. First, we examine the evidence that inequalities in the social determinants of health are causally related to health inequalities. Second, we discuss whether more egalitarian social policies provide a solution to redressing health inequalities. In conclusion, we suggest that current debates around causal understandings risk sending the field down ‘rabbit holes’ that distract from solution. We argue that, if we combine epidemiological evidence with the broader canon of social science evidence, the case for causal inference is sufficiently strong to suggest we now need to focus on effectively supporting and promoting research-informed policy responses to health inequalities.
Original languageEnglish
Pages (from-to)37-47
Number of pages11
JournalCritical Public Health
Issue number1
Early online date7 Feb 2022
Publication statusPublished - 7 Feb 2022

Bibliographical note

Funding MKI receives funding from Horizon 2020 European research Council (Gendhi-Synergy grant agreement SGY2019-856478). WB is supported by The Health Foundation as part of the Networked Data Lab partnership. RD is supported by the Medical Research Council MC_UU_00022/2] and the Scottish Government Chief Scientist Office [SPHSU17]. CB is funded by CHAIN: Centre for Global Health Inequalities Research (Norwegian Research Council, grant reference Norges Forskningsrad 288638). Kat Smith is partly funded by the UK Prevention Research Partnership SIPHER Consortium (MR/S037578/1), an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England), the UK devolved administrations, and leading health research charities.


  • Health inequities
  • Health inequalities
  • Socioeconomic factors
  • Social determinants of health
  • Welfare


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