Income distribution and health in Latin America. The interplay between social determinants of health for explaining health inequities

Sammanfattning: Even though there is persuasive evidence to support the association between income distribution and health, research in the field is still progressing. There are questions, for instance, about the significance of the association in different countries and about the mechanisms linking income distribution and health. Addressing these issues, this doctoral thesis explores the influence of income distribution and other related social determinants of health on health and well-being, focusing on Latin American countries. To further understand the mechanisms linking income distribution and health, this thesis investigates who is affected and how people are affected by inequality. A multi-methods approach was used. First, different quantitative studies were conducted. Second, a qualitative analysis was performed to gain a deeper understanding of the relationship between inequality and health. Various data sources, populations, study designs and analytical methods were used to explore the association between income distribution and health, the interplay of contextual factors and how these factors are manifested in people’s lives. The findings support the notion that income distribution affects the health in Latin American countries. The direct association between income inequality and worse health outcomes is demonstrated. Income distribution is also shown to modify the social gradient in health and further to interact with other contextual factors—social capital and neighborhood infrastructure—influencing health and health distribution. The qualitative analysis led to the development of one core category “Constructing social identity through multiple us and them” which describes how people in a vulnerable district socially situate themselves based on several factors, with varying influence on social stress, health and well-being. Internal and external aspects of the construction of social identities illustrate and characterize the intersection between self and context, bridging concepts like downward social comparison, territorial stigmatization and erosion of social capital. These qualitative findings are complementary to the quantitative ones characterizing and further supporting the relevance of the interplay between social determinants of health in explaining health inequities. Finally, this research may help to understand the links between income distribution, overall context and health.