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Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities
Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark; Fundacao Oswaldo Cruz, Dept Saude Colet, Recife, PE, Brazil.ORCID iD: 0000-0002-9998-4972
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Univ Liverpool, Dept Publ Hlth & Policy, Liverpool, Merseyside, England.
2019 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 1, p. 268-274Article in journal (Refereed) Published
Abstract [en]

This paper discusses the concepts of vulnerability and susceptibility and their relevance for understanding and tackling health inequalities. Tackling socioeconomic inequalities in health is based on an understanding of how an individual's social position influences disease risk. Conceptually, there are two possible mechanisms (not mutually exclusive): there is either some cause(s) of disease that are unevenly distributed across socioeconomic groups (differential exposure) or the effect of some cause(s) of disease differs across groups (differential effect). Since differential vulnerability and susceptibility are often used to denote the latter, we discuss these concepts and their current use and suggest an epidemiologically relevant distinction. The effect of social position can thus be mediated by causes that are unevenly distributed across social groups and/or interact with social position. Recent improvements in the methodology to estimate mediation and interaction have made it possible to calculate measures of relevance for setting targets and priorities in policy for health equity which include both mechanisms, i.e. equalize exposure or equalize effects. We finally discuss the importance of differential susceptibility and vulnerability for the choice of preventive strategies, including approaches that target high-risk individuals, whole populations and vulnerable groups.

Place, publisher, year, edition, pages
2019. Vol. 48, no 1, p. 268-274
Keywords [en]
Health equity, disease susceptibility, vulnerability, socioeconomic factors, public health policy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-382670DOI: 10.1093/ije/dyy167ISI: 000463862500035PubMedID: 30085114OAI: oai:DiVA.org:uu-382670DiVA, id: diva2:1314096
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-05-07Bibliographically approved

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Hallqvist, Johan

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