Glossary of terms

We use a lot of different terms in this toolkit and in the wider DRIVERS work. We list some on this page; references can be found at the bottom.

Advocacy for health equity

In DRIVERS we defined advocacy for health equity as “a deliberate attempt to influence decision makers and other stakeholders to support or implement policies that contribute to improving health equity using evidence”. This stands in contrast to other kinds of advocacy, such as patient advocacy, which aims to ensure patients obtain the necessary care they are entitled to, and mental health advocacy which aims to challenge discrimination faced by past and present users of mental health services.

Campaigning

Campaigning is a deliberate course of action to achieve political, social, economic or environmental change. Examples of activities that may be part of campaigning include letter writing, lobbying, organising demonstrations, vigils and various publicity-raising actions. Campaigning is often (but not always) part of building a social movement of different stakeholders capable of more effectively achieving desired change(s). See also: Social movement, Stakeholders.

Civil society

Civil society is a social sphere separate from both the state and the market. See also: Civil society organisation.

Civil society organisation

Civil society organisations (CSOs) are non-state, non-profit voluntary organisations formed to further certain social or environmental objectives. The term is used to describe a wide range of organisations, networks, associations, groups and movements that are independent from government and which sometimes come together to advance their common interests through collective action as part of campaigns or social movements. Although often treated synonymously with non-governmental organisations (NGOs), CSOs may also refer to those organisations that work more closely within communities, which rely more on voluntary rather than professional staff, have less permanent or official statues, and which place less of an emphasis on producing research, lobbying, or running services for government. See also: Campaigning, Non-governmental organisation, Social movement.

Community

A community is a set of interactions and human behaviours that have shared meaning and expectations between members. Although communities may be defined by geographical proximity or a common language, a community does not necessarily need to be located in a physical location and may refer instead to a group of people with a common interest (1). See also: Society.

Corporate Social Responsibility (CSR)

CSR is a management concept whereby companies integrate social and environmental concerns in their business operations and interactions with their stakeholders. CSR is generally understood as being the way through which a company achieves a balance of economic, environmental and social imperatives while at the same time addressing the expectations of shareholders and stakeholders.

Determinants of health

While access to healthcare services and medicine are determinants of health, biological (e.g. genetic), physical/environmental (e.g. the living environment or pollution) and social factors (e.g. socio-economic status, type of work, family and support networks) all combine to determine the health of individuals and communities. See also: Social determinants of health.

Disparities in health

Health disparities refer to differences in health between given social categories, for example racial groups or the richest and the poorest. The term is more popularly used in the USA, while “inequalities in health” tends to be used in European discourse. See also: Health inequalities.

Effective (advocacy for health equity)

By effective, we refer to an advocacy effort’s likelihood of having the intended effect(s) and expected outcome(s). These could include having research evidence understood by decision makers, obtaining the support of politicians or businesses for a policy proposal or changing the terms of a debate about the allocation of resources. Whether an advocacy effort is likely to be effective or not should be gauged against evidence but because advocacy is so context dependent it may be difficult to derive useful lessons from research methods that produce the very highest standards of evidence. See also: Advocacy for health equity, Evidence, Hierarchy of evidence.

Evidence

Commonly understood as knowledge derived from qualitative and quantitative research and intended to be used to support a conclusion. A conclusion, in turn, may be composed of many different pieces of evidence arrived at by different research methods. There are disagreements over the qualities of evidence arising from different research methods, to the extent that “the value of evidence is in the eye of the beholder” (2, 3). While the ‘hierarchy of evidence’ can be a useful tool for assessing the strength of evidence, policy makers and other decision makers also value ‘lower standards of evidence’ in making decisions (4-6). See also: Knowledge transfer and translation, Hierarchy of evidence.

Evidence-based policy (EBP)

Evidence-based policy is the notion or a ssertion that public policy should be informed by rigorously established objective evidence. However, policy makers and scientists may not agree on what constitutes established objective evidence. Research suggests that a ‘jigsaw of different kinds of evidence’ is most likely to help support EBP concerning health inequalities (6). Concerns are frequently raised that evidence is used to support pre-conceived policy decisions rather than vice versa, and that the most important policy decisions (e.g. concerning economic policies, foreign affairs, etc.) are made in the complete absence of evidence. See also: Evidence, Hierarchy of evidence.

Equity in health

See instead: Health equity.

Gradient in health

See instead: Socio-economic gradient in health.

Health

Health can be defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (7). See also: Well-being.

Health equity

Health equity is “an ethical concept, grounded in the principle of distributive justice” (8) which refers to the absence of systematic inequalities in health. Since inequalities are so pervasive and are linked to many different factors (e.g. biological, physical/environmental, behavioural, social, etc.), this term is usually used in aspirational terms. The policy goal of moving towards equity in health therefore implies attempts to reduce health inequalities to a minimal level, though this minimal level may not be defined. See also: Health inequalities.

Health inequalities

Health inequalities are differences in the distribution of various measures of health between defined population groups. Some health inequalities are attributable to biological factors or behavioural choices while others are attributable to the external environment and conditions that lay mainly outside the control of the individuals concerned. Many others are more likely to result from interplay between the environment, social stratification and human behaviour. This leads some scholars to talk about the ‘causes of the causes’ of health inequalities. In contrast to disparities in health, which usually refer to racial or ethnic differences in health, health inequalities are measured across population groups rather than being concerned with comparisons between specific socially defined groups (9-10). See also: Health equity.

Health services

Any service which contributes to improved health, or the diagnosis, treatment and rehabilitation of the sick and therefore not necessarily limited to medical or healthcare services.

Health policy

Health policy refers to decisions, plans and actions that are undertaken to achieve specific healthcare goals in a society. A health policy can achieve several things: it can define a vision for the future which in turn helps to establish targets and points of reference for the short and medium term, it can outline priorities and the expected roles of different groups, and it can build consensus and inform people. Increasingly, health policy is developed with a view to engaging with non-healthcare sectors, as many of the social determinants of health lie outside the responsibility of the healthcare sector. See also: Health in all policies, Intersectoral co-operation, Sector.

Health in all Policies (HiAP)

Many policy sectors have an impact on health, so health logically needs to be taken into account by non-health sectors, for example environment, transport, social affairs, etc. HiAP is a strategy for ensuring that non-health sectors can help achieve health gains, and entails encouraging intersectoral co-operation between different sectors. See also: Sector, Intersectoral co-operation.

Hierarchy of evidence

A hierarchy said to reflect the relative authority and strength of different types of biomedical research. Randomised controlled trials (RCTs) generally rank above cohort studies, and case-controlled studies rank above cross-sectional surveys. There is debate about how useful the hierarchy of evidence is in health inequalities research, as many of the SDH are not amenable to study using RCTs. Instead, the ‘lowest standards’ of evidence often provide information about practices, perceptions, cultural contexts, reasons why interventions work, and can generate hypotheses that can be tested using research methods associated with higher standards of evidence. As a result, researchers have found that filtering out all but the ‘highest standards of evidence’ can result in useful studies - and evidence - being missed. A helpful way forward in organising and appraising public health evidence could be to consider methodological appropriateness, that is, whether the research method can convincingly answer the question being asked (11-14). See also: Evidence.

Inequalities in health

See instead: Health inequalities.

Intersectoral co-operation

Intersectoral co-operation refers to co-operation between different sectors to achieve an aim. It is encouraged as part of a strategy of Health in All Policies (HiAP). See also: Health in All Policies, Sector.

Intervention

An activity or activities that aim to modify a process, course of action or sequence of events. In health policy, this may refer to activities to improve health while in employment policy; this may refer to a programme to help reduce unemployment (15).

Knowledge transfer and translation

Knowledge transfer (KT) is a term used to describe the one-way flow of evidence from researchers to potential users of the evidence, which includes policy makers, clinicians and clients. Lomas categorised three types of transfer activities: 1) diffusion – promoting general awareness, via journals, newsletters, websites and mass media; 2) dissemination – sharing research findings with particular stakeholders, for example in workshops or seminars; 3) implementation – discussing barriers to implementation, for example through face-to-face meetings with experts. Concerns have been raised about the effectiveness of KT because researchers, policy makers and clinicians inhabit ‘different cultural worlds’ and knowing the evidence does not necessarily lead to being used in the making of decisions. Attention has thus shifted to bridging this ‘cultural gap’, by translating knowledge so that it ‘resonates’ with the target audience’s culture. Translation activities include consideration of 1) the message, 2) the target audience, 3) the messenger, 4) the knowledge transfer process and infrastructure, 5) evaluation of success and effectiveness. We term both sets of practices Knowledge Transfer and Translation (16-18). See also: Evidence.

Levelling up

A policy strategy to reduce health inequalities by improving the health status of disadvantaged groups to the level enjoyed by non-disadvantaged groups. The term is partly a response to criticism that policy strategies to reduce health inequalities can worsen the health of those who enjoy better health. Levelling up suggests instead that health inequalities can be reduced by improving the health of the worst off rather than by reducing the health of those who (currently) enjoy better health. Some scholars argue that levelling up should be a part of all local, national and international policies to increase population health (19-21). See also: Socio-economic gradient in health.

Lobbying

Lobbying is one of the techniques and practices used as part of campaigning. Lobbying builds relationships with elected officials and tries to provide them with information, educate and persuade them to take certain courses of action when making decisions or voting on legislation. See also: Advocacy, Campaigning.

Non-governmental organisations (NGOs)

By definition, all civic groups (civil society organisations) are NGOs, in that they are organisations that are not affiliated with government and not part of the market. However, the term NGO is usually used to describe organisations that seek to influence the policy of governments and international organisations and/or to complement government services (such as health and education). They usually have a formal structure, offer services to people other than their members, and are, in most cases, registered with national authorities. See also: Civil society organisation.

Policy

A policy is an agreement or consensus on issues, goals and objectives which need to be addressed.

Policy maker

Policy makers are those whose professional responsibility it is to develop and organise the making of decisions in various policy making sectors. Policy makers generally refer to those employed within government (be that local, regional, national or international), but since many policy decisions also depend on activating and working with different stakeholders, policy makers can also be found in other kinds of quasi-governmental organisations and even NGOs. Policy makers are often used as a catch-all term, though it may be helpful to differentiate between decision makers (who are often elected and may lack technical knowledge of a subject) and expert policy makers (who may be specialist experts on one or another subject area). See also: Non-governmental organisations, Sectors, Stakeholders.

Public health

Public health refers to all organised measures (whether public or private) to prevent disease, promote health, and prolong life among the population.

Proportionate universalism

Proportionate universalism is a strategy to reduce the steepness of the social gradient in health by implementing policies that level up the health of those who experience worse health. Proportionate universalism states that actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. Greater intensity of action is therefore likely to be needed for those who are more socially and economically disadvantaged. Conversely, focusing solely on the most disadvantaged to reduce health inequalities runs the risk of eroding popular support for policies and interventions and generally only aims to improve the health of the very worst health, rather than across the gradient of health. See also: Health inequalities, Levelling up, Socio-economic gradient in health.

Sector

A sector refers to a particular area of human activity (e.g. employment, agriculture, environment, defence, etc.). These areas may be divided in different ways at local, regional, national or international levels. See also: Intersectoral co-operation, Stakeholder.

Social capital

Social capital refers to the institutions, relationships, and norms that shape the quality and quantity of a society’s social interactions. It is argued that social capital is not just the sum of the institutions which underpin a society, but also the glue that holds them together. Low levels of social capital are said to hinder economic and social development. Some dispute that the term is a useful scientific concept.

Social determinants of health

The social determinants of health are the conditions into which people are born, grow, live, work and age. These conditions are shaped by the distribution of money, power and resources at global, national and local levels. Their distribution, in turn, can be altered through the implementation of policy. It has been argued that the social determinants of health are responsible for much of the inequality in health within and between countries.

Socio-economic gradient in health

Refers to the linear or step-wise decrease in health that comes with decreasing social position. It represents the association between socio-economic position and health across the whole population. However health is measured, there tends to be a gradient where the more socially advantaged a person or group is, the better their health is. Over time, the gradient as a whole tends to shift upwards because the health of most groups is improving. However, the degree and rate of improvement tends to be greater in more advantaged social groups, meaning that relative differences, and therefore the degree of inequalities, also tend to increase (22). See also: Inequalities in health.

Social inclusion

Social Inclusion is the process of improving participation in society. Efforts are usually made to include people socially when they face situations that exclude them from society, as a result of hardship, disabilities, lack of financial means, etc. Social inclusion ensures that people have a voice in decisions which affect their lives and that they enjoy equal access to markets, services and political, social and physical spaces.

Social indicators

A feature of a society that is measured because it is considered to reveal some underlying aspect of social reality. Measurement of social indicators over time is used to assess the extent to which a society is developing or ‘progressing’. For this reason, social indicators are an important aspect of policy-related studies, and are widely used by governments (23).

Social justice

Social justice is normally understood to be ‘a question of equal opportunity’. Consequently, remedial inequities in society are considered a matter of social justice. See also: Socio-economic gradient in health.

Social mobilisation

Social mobilisation is a process that aims to motivate a wide range of stakeholders, usually including civil society groups and non-governmental organisations, to demand particular development objectives or policies. Social mobilisation is often part of the strategy of creating a social movement (24). See also: Civil society organisation, Non-governmental organisation, Social movement.

Social movement

A social movement comprises individuals and groups that share political goals and take action to achieve that goal. Social movements often develop ‘umbrella’ organisations to co-ordinate the actions of the different groups involved. See also: Campaigning, Civil society organisation, Non-governmental organisations.

Society

The concept of society is relational and not substantive; the only 'real' entities in any given social situation are individuals. The term society is therefore used to highlight the fact that people are related to one another, whether closely or distantly, in various institutionalised and non-formal ways. As such, societies are often understood as comprising various overlapping communities, which may share certain values between them. See also: Community.

Stakeholders

Stakeholders are organisations as well as individuals that have a direct or indirect role (or “stake”) in the objectives, outcomes or activities of a policy or intervention. They typically include government institutions and services, non-governmental and civil society organisations, the private sector and the population directly affected by that policy or intervention. See also: Civil society organisation, Intervention, Non-governmental organisation, Policy.

Target

A target is an objective that a policy or intervention seeks to achieve within a specified time frame and using finite resources. It is usually specific and lends itself more readily to being expressed in quantitative terms. See also: Intervention, Policy.

Value

A target is an objective that a policy or intervention seeks to achieve within a specified time frame and using finite resources. It is usually specific and lends itself more readily to being expressed in quantitative terms. See also: Intervention, Policy.

Well-being

Although the concept of well-being is widely used, there is no commonly agreed definition of what it constitutes. It usually refers to a situation in which an individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others, and contributes to and finds meaning in their community. Health is usually considered an intrinsic part of this, because without good health, one is not able to do those things. The terms 'quality of life', 'happiness' and 'life satisfaction' are often used interchangeably with well-being. See also: Health.

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