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Concepts and principles for tackling social inequities in health.  Levelling up.  Part 1

Between 1992 and 2002, the gap between Europe’s healthiest and least healthy citizens widened, creating challenges for policy makers working for greater social and health equity. The World Health Organization’s Collaborating Centre for Policy Research on Social Determinants of Health asked Whitehead and Dahlgren to revisit ground-breaking work they did in the early 90s to raise awareness and stimulate public debate on the elusive topic of health equity. 

This discussion paper translates complex concepts for non-technical audiences. It describes the difference between “variations in health” and “social inequities in health”; it distinguishes between what equity in health care looks like, versus the look of broader, socially-based health equity.  The authors propose 10 principles for policy action to advance health equity, and in the process clarify key concepts like “social gradient” and “levelling up.”  In principle #2, they present the three main approaches to addressing health inequities‒‒1) focusing only on people in poverty (targeting); 2) focussing on the health of disadvantaged populations relative to that of other groups (narrowing the health divide); and 3) reducing inequities throughout the whole population‒‒and argue that these approaches are interdependent and should be addressed sequentially.  They conclude that “… to make it absolutely clear, … the only way to narrow the health gap in an equitable way is to bring up the level of health of the groups of people who are worse off to that of the groups who are better off. Levelling down is not an option.” (p. 14) 

Use this report to:

  • Improve your understanding of key concepts in health equity and how these concepts relate to action
  • Explain health inequity to people new to the concept
  • Explore core principles that provide a values base for strategies and actions aimed at reducing health inequity

The authors have written a companion document - European strategies for tackling social inequities in health: Levelling up Part 2 (2006) in which they present evidence about the nature and extent of health inequities in Europe, and offer policy options to tackle the problems. 

Whitehead, M. & Dahlgren, G.  (2006). Concepts and principles for tackling social inequities in health: Levelling up part 1. University of Liverpool: WHO Collaborating Centre for Policy Research on Social Determinants of Health. Retrieved from the WHO website:

Tags: Critical works in health equity, Income inequality, Key concepts, Document

What people are saying

  • Hi,  the link to Levelling Up Part 1 doesn’t seem to work anymore…alternate?

  • Hi Jane, I am looking into why that link isn’t working. In the meantime, if you cut and paste this link in your browser you should be able to access the PDF. Let me know if you need anything else:


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