Theories of population health: A review of pictorial models and a proposal for the Political Economy and Health model
DOI:
https://doi.org/10.55016/wvqqx429Keywords:
theory, population health, health inequality, social groups, powerAbstract
The current global polycrisis, and the threats it poses for population health, demands theory which moves beyond social, commercial, environmental or political determinants of health. By synthesising the strengths of existing models into a political economy framework, it is possible to better integrate the links, propose causal pathways, and more effectively incorporate relational theories of power and social class. How we theorise and understand the causes of population health influences how it is prioritised, the research questions asked, the recommendations made, and who is held responsible for it. In this paper we review notable pictorial models of population health in order to identify their common and divergent features, and to expose the underlying assumptions, values and implications of each. Each model is critically assessed for the extent to which they provide a causal flow and include a sufficient range of exposures and social processes. Building on their pre-eminent features, and incorporating theories of health and political economy, power, and social relations, we propose the ‘Political Economy and Health model’ to improve the potential for public health policy, practice and research to be less complacent and more transformative in the face of 21st Century challenges.
References
Bambra, C. (2011) Health inequalities and welfare state regimes: Theoretical insights on a public health ‘puzzle.’ Journal of Epidemiology and Community Health, 65(9), 740. https://doi.org/10.1136/jech.2011.136333
Bambra, C., & Marmot, M. (2023) Expert report for the UK Covid-19 Public Inquiry. Module 1: Health inequalities. UK Covid-19 Public Inquiry. https://covid19.public-inquiry.uk/documents/inq000195843-expert-report-by-professor-clare-bambra-and-professor-sir-michael-marmot-dated-30-may-2023/
Basu, S., Carney, M. A., & Kenworthy, N. J. (2017) Ten years after the financial crisis: The long reach of austerity and its global impacts on health. Social Science & Medicine, 187, 203–207. https://doi.org/10.1016/j.socscimed.2017.06.026
Baum, F., Anaf, J., Freeman, T., Musolino, C., van den Berg, M., Friel, S., & Schram, A. (2025) Twenty-first century alienation and health: A research agenda. Journal of Epidemiology and Community Health, 79, 481-483. https://doi.org/10.1136/jech-2024-223112
Beckfield, J., & Krieger, N. (2009) Epi + demos + cracy: Linking political systems and priorities to the magnitude of health inequities—evidence, gaps, and a research agenda. Epidemiologic Reviews, 31(1), 152–177. https://doi.org/10.1093/epirev/mxp002
Black, D., Morris, J. N., Smith, C., & Townsend, P. (1988) Inequalities in health: The Black Report. Penguin.
Borrell, C., Espelt, A., Rodríguez-Sanz, M., & Navarro, V. (2007) Politics and health. Journal of Epidemiology and Community Health, 61(8), 658-659. https://doi.org/10.1136/jech.2006.059063
Braveman, P. (2022) Defining health equity. Journal of the National Medical Association, 114(6), 593–600. https://doi.org/10.1016/j.jnma.2022.08.004
Breilh, J. (2021) Why critical epidemiology?: Daring ethical science in an unhealthy civilization. In J. Breilh & N. Krieger, Critical epidemiology and the people’s health (pp. 47-132). Oxford University Press. https://doi.org/10.1093/med/9780190492786.003.0003
Breilh, J. (2023) The social determination of health and the transformation of rights and ethics. Global Public Health, 18(1), 2193830. https://doi.org/10.1080/17441692.2023.2193830
Brook, A., Rendall, G., Hearty, W., Meier, P., Thomson, H., Macnamara, A., … & McCartney, G. (2024) What is the relationship between changes in the size of economies and mortality derived population health measures in high income countries: A causal systematic review. Social Science & Medicine, 357, 117190. https://doi.org/10.1016/j.socscimed.2024.117190
Buse, K., Bestman, A., Srivastava, S., Marten, R., Yangchen, S., & Nambiar, D. (2023) What are healthy societies? A thematic analysis of relevant conceptual frameworks. International Journal of Health Policy and Management, 12(1), 1–12. https://doi.org/10.34172/ijhpm.2023.7450
Collins, C., McCartney, G., & Garnham, L. (2016) Neoliberalism and health inequalities. In K. E. Smith, C. Bambra, & S. E. Hill (Eds.), Health Inequalities: Critical perspectives (pp. 124–137). Oxford University Press.
Dahlgren, G., & Whitehead, M. (2021) The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health, 199, 20–24. https://doi.org/10.1016/j.puhe.2021.08.009
Darity, W. A., Jr. (2022) Position and possessions: Stratification economics and intergroup inequality. Journal of Economic Literature, 60(2), 400–426. https://doi.org/10.1257/jel.20211690
Davies, S. C., Winpenny, E., Ball, S., Fowler, T., Rubin, J., & Nolte, E. (2014) For debate: A new wave in public health improvement. The Lancet, 384(9957), 1889–1895. https://doi.org/10.1016/S0140-6736(13)62341-7
Davis, J. B. (2024) Identity, capabilities, and changing economics: Reflexive, adaptive, socially embedded individuals. Cambridge University Press.
Dawes, D. E., Amador, C. M., & Dunlap, N. J. (2022) The political determinants of health: A global panacea for health inequities. Oxford University Press. https://doi.org/10.1093/acrefore/9780190632366.013.466
Dawson, M. (2025) Marxism on Musk: Reflections on Baum et al.’s ‘Twenty-first century alienation and health.’ Journal of Epidemiology and Community Health, 79, 477-478. https://doi.org/10.1136/jech-2025-223762
Diderichsen, F., Hallqvist, J., & Whitehead, M. (2019) Differential vulnerability and susceptibility: How to make use of recent development in our understanding of mediation and interaction to tackle health inequalities. International Journal of Epidemiology, 48(1), 268–274. https://doi.org/10.1093/ije/dyy167
Doyal, L., & Pennell, I. (1979) The political economy of health. Pluto Press.
Feeney, M., & Collins, C. (2015) Tea in the pot: Building ‘social capital’ or a ‘great good place’ in Govan? Collaborative Reports Series, 3. UWS-Oxfam Partnership. https://myresearchspace.uws.ac.uk/ws/portalfiles/portal/51893121/2015_03_31_Feeney_Final.pdf
Floud, R., Fogel, R. W., Harris, B., & Hong, S. C. (2014) Health, mortality and the standard of living in Europe and North America since 1700. Edward Elgar.
Friel, S., Townsend, B., Fisher, M., Harris, P., Freeman, T., & Baum, F. (2021) Power and the people’s health. Social Science & Medicine, 282, 114173. https://doi.org/10.1016/j.socscimed.2021.114173
Gilmore, A. B., Fabbri, A., Baum, F., Bertscher, A., Bondy, K., Chang, H.-J., … &Thow, A. M. (2023) Defining and conceptualising the commercial determinants of health. The Lancet, 401(10383), 1194–1213. https://doi.org/10.1016/S0140-6736(23)00013-2
Givens, M. L., Catlin, B. B., Johnson, S. P., Pollock, E. A., Faust, V. N., Inzeo, P. T., & Kindig, D. A. (2020) What do we know about the drivers of health and equity? A narrative review of graphic representations. Health Equity, 4(1), 446–462. https://doi.org/10.1089/heq.2020.0013
Hanlon, P., Carlisle, S., Hannah, M., Reilly, D., & Lyon, A. (2011) Making the case for a ‘fifth wave’ in public Health. Public Health, 125(1), 30–36. https://doi.org/10.1016/j.puhe.2010.09.004
Harvey, D. (2021) The political economy of health: Revisiting its Marxian origins to address 21st-century health inequalities. American Journal of Public Health, 111, 293–300. https://doi.org/10.2105/AJPH.2020.305996
Heller, J. C., Fleming, P. J., Petteway, R. J., Givens, M., & Pollack Porter, K. M. (2023) Power up: A call for public health to recognize, analyze, and shift the balance in power relations to advance health and racial equity. American Journal of Public Health, 113(10), 1079–1082. https://doi.org/10.2105/AJPH.2023.307380
Heller, J. C., Givens, M. L., Johnson, S. P., & Kindig, D. A. (2024) Keeping it political and powerful: Defining the structural determinants of health. The Milbank Quarterly, 102(2), 351–366. https://doi.org/10.1111/1468-0009.12695
Ho, J. Y., & Hendi, A. S. (2018) Recent trends in life expectancy across high income countries: Retrospective observational study. BMJ, 362, k2562. https://doi.org/10.1136/bmj.k2562
Krieger, N. (1994) Epidemiology and the web of causation: Has anyone seen the spider? Social Science & Medicine, 39(7), 887–903. https://doi.org/10.1016/0277-9536(94)90202-X
Krieger, N. (2001) Theories for social epidemiology in the 21st century: An ecosocial perspective. International Journal of Epidemiology, 30(4), 668–677. https://doi.org/10.1093/ije/30.4.668
Krieger, N. (2008) Proximal, distal, and the politics of causation: What’s level got to do with it? American Journal of Public Health, 98(2), 221-230.
Krieger, N. (2011) Epidemiology and the people’s health. Theory and context. Oxford University Press.
Krieger, N. (2014a) Got theory? On the 21st c. CE rise of explicit use of epidemiologic theories of disease distribution: A review and ecosocial analysis. Current Epidemiology Reports, 1(1), 45–56. https://doi.org/10.1007/s40471-013-0001-1
Krieger, N. (2020) Measures of racism, sexism, heterosexism, and gender binarism for health equity research: From structural injustice to embodied harm—an ecosocial analysis. Annual Review of Public Health, 41(1), 37–62. https://doi.org/10.1146/annurev-publhealth-040119-094017
Link, B. G., & Phelan, J. (1995) Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, (Extra Issue), 80–94. https://doi.org/10.2307/2626958
Lynch, J. (2020) Regimes of inequality: The political economy of health and wealth. Cambridge University Press.
McCartney, G. (2022) Political economy and population health: From theory to an empirical assessment of the impact of austerity on mortality trends. [PhD, University of Glasgow]. https://theses.gla.ac.uk/83260/
McCartney, G., Bartley, M., Dundas, R., Katikireddi, S. V., Mitchell, R., Popham, F., Walsh, D., & Wami, W. (2019) Theorising social class and its application to the study of health inequalities. SSM Population Health, 7, 100315. https://doi.org/10.1016/j.ssmph.2018.10.015
McCartney, G., Büchs, M., Hensher, M., & Mazzei, M. (2025) What is a Wellbeing Economy, and what might its impact be on population health? The Lancet Public Health, 10(10), e879–e889. https://doi.org/10.1016/S2468-2667(25)00192-6
McCartney, G., Dickie, E., Escobar, O., & Collins, C. (2021) Health inequalities, fundamental causes and power: Towards the practice of good theory. Sociology of Health & Illness, 43(1), 20–39. https://doi.org/10.1111/1467-9566.13181
McCartney, G., Hearty, W., Arnot, J., Popham, F., Cumbers, A., & McMaster, R. (2019) Impact of political economy on population health: A systematic review of reviews. American Journal of Public Health, 109(6), e1–e12. https://doi.org/10.2105/AJPH.2019.305001
McCartney, G., McMaster, R., Shipton, D., Harding, O., & Hearty, W. (2022) Glossary: Economics and health. Journal of Epidemiology and Community Health, 76(5), 518. https://doi.org/10.1136/jech-2021-218244
McCartney, G., Popham, F., McMaster, R., & Cumbers, A. (2019) Defining health and health inequalities. Public Health, 172, 22–30. https://doi.org/10.1016/j.puhe.2019.03.023
Muntaner, C., & Gunn, V. (2019) In defense of class wars in population health: The new landscape of social class with Bourdieu, neo-Marxists, and the Kohn/Schooler/Wright Integrative Models. International Journal of Health Services, 49(1), 102–107. https://doi.org/10.1177/0020731418818409
Muntaner, C., Gunn, V., & Prins, S. J. (2025) Alienation: Another contested Marxian construct in epidemiology and public health. Journal of Epidemiology and Community Health, 79(8), 569-70. https://doi.org/10.1136/jech-2025-223840
Muntaner, C., Lynch, J. W., Hillemeier, M., Lee, J. H., David, R., Benach, J., & Borrell, C. (2002) Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries. International Journal of Health Services, 32(4), 629–656. https://doi.org/10.2190/N7A9-5X58-0DYT-C6AY
Muntaner, C., Ng, E., Chung, H., & Prins, S. J. (2015) Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction. Social Theory & Health, 13(3), 267–287. https://doi.org/10.1057/sth.2015.17
Navarro, V. (1977) Social class, political power, and the state and their implications in medicine. International Journal of Health Services, 7(2), 255–292. https://doi.org/10.2190/WPNY-UR3N-0DH9-JTA4
Navarro, V., Muntaner, C., Borrell, C., Benach, J., Quiroga, Á., Rodríguez-Sanz, M., Vergés, N., & Pasarín, M. I. (2006) Politics and health outcomes. The Lancet, 368(9540), 1033–1037. https://doi.org/10.1016/S0140-6736(06)69341-0
Noonan, R. J. (2024) What are the roots of the nation’s poor health and widening health inequalities? Rethinking economic growth for a fairer and healthier future. Community Health Equity Research & Policy, 45(4), 395-404. https://doi.org/10.1177/2752535X241259241
Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004) “Fundamental causes” of social inequalities in mortality: A test of the theory. Journal of Health and Social Behavior, 45(3), 265–285. https://doi.org/10.1177/002214650404500303
Phelan, J. C., Link, B. G., & Tehranifar, P. (2010) Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(1_suppl), S28–S40. https://doi.org/10.1177/0022146510383498
Piketty, T. (2014) Capital in the twenty-first century. Harvard University Press.
Rabinowitz, P. M., & Barry, M. (2024) Environmental determinants of health—Time to redefine the social history? JAMA, 332(22), 1881–1882. https://doi.org/10.1001/jama.2024.19490
Rahman, R., Reid, C., Kloer, P., Henchie, A., Thomas, A., & Zwiggelaar, R. (2024) A systematic review of literature examining the application of a social model of health and wellbeing. European Journal of Public Health, 34(3), 467–472. https://doi.org/10.1093/eurpub/ckae008
Smith, G. D. (2011) Epidemiology, epigenetics and the ‘Gloomy Prospect’: Embracing randomness in population health research and practice. International Journal of Epidemiology, 40(3), 537–562. https://doi.org/10.1093/ije/dyr117
Solar, O., & Irwin, A. (2010) Conceptual framework for action on the social determinants of health. Discussion paper for the Commission on Social Determinants of Health. World Health Organization. https://iris.who.int/handle/10665/44489
Virchow, R. (1848) Mittheilungen über die in Oberschlesien herrschenden Typhus-Epidemie. Georg Andreas Reimer Verlag.
Walsh, D., & McCartney, G. (2025) ‘Social murder’? Austerity and life expectancy in the UK. Policy Press.
Wami, W., McCartney, G., Bartley, M., Buchanan, D., Dundas, R., Katikireddi, S. V., Mitchell, R., & Walsh, D. (2020) Theory driven analysis of social class and health outcomes using UK nationally representative longitudinal data. International Journal for Equity in Health, 19(1), 193. https://doi.org/10.1186/s12939-020-01302-4
Whitehead, M., & Dahlgren, G. (1991) Policies and strategies to promote social equity in health. Institute for Futures Studies.
Whitley, E., McCartney, G., Bartley, M., & Benzeval, M. (2022) Examining the impact of different social class mechanisms on health inequalities: A cross-sectional analysis of an all-age UK household panel study. Social Science & Medicine, 312, 115383. https://doi.org/10.1016/j.socscimed.2022.115383
WHO (World Health Organization) (2008) Closing the gap in a generation: Health equity through action on the social determinants of health. WHO Commission on the Social Determinants of Health.
WHO (World Health Organization) (2021) The Geneva Charter for well-being. World Health Organization. https://www.who.int/publications/m/item/the-geneva-charter-for-well-being
Wright, E. O. (2010). Envisioning real utopias. Verso.
Wright, E. O. (2015) Understanding class. Verso.
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