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Community participation in health in Chile during the Unidad Popular Government contributes to a critical understanding of community participation, conceived as a dialectic and transformative action. In this context, the pobladores constituted themselves as social subjects who actively transformed Chilean health institutions by challenging the dominant and oppressive hierarchies in society.

Source: Hadjez-Berrios (2014)

In a review of what it would take to eradicate health inequalities, a report for NHS Scotland (Scott et al., 2013: 6) concluded that this can only be achieved ‘if the underlying differences in income, wealth and power across society are reduced’. In a similar report, McCartney et al. (2012) reviewed the evidence for the higher rate of mortality in Scotland. They concluded that the continued high rates of mortality, despite improvements in health care, can be accounted for by a ‘synthesis that begins from the changed political context of the 1980s, and the consequent hopelessness and community disruption experienced’ (2012: 459). Their summary of this synthesis of the evidence is presented in Figure 5.1.

It is a challenge for health psychologists to position themselves within this movement for change, but it is something that we need to reflect on as scholars and activists (Murray, 2012b). The life of Miguel D’Escoto Brockmann (1933–2017), whose frequently quoted exhortation opened this chapter, reminds us of this challenge. D’Escoto was a priest, a member of Nicaragua’s Sandinista government in the 1980s and ex-president of the UN General Assembly, whose commitment to social justice leaves a legacy and an inspiration. There is a need for a more social and political health psychology that is informed by contemporary debates about social change, but is also committed to the ideals of social justice (Murray, 2012; Tileaga, 2013).

Figure 5.1 Representation of the synthesis of evidence of the cause of the higher rate of mortality in Scotland

Source: Reproduced with permission from McCartney et al., 2012

Future Research

1 There is a need to clarify the character of the psychosocial explanations for the social inequalities in health.

2 Research on social inequalities needs to be combined with further research on ethnic and gender inequalities in health. Qualitative studies of the health experiences of people from different socio-economic backgrounds are of particular importance to our understanding of the psychological mechanisms underlying health variations. Further qualitative studies are also needed to explore the relationship between social positioning and health experience.

3 Forms of research on social inequalities in health need to explicitly consider how they can contribute to reducing them.

4 An essential aspect of future research is to consider the social and psychological obstacles to movements to alleviate social inequalities in health.

Summary

1 Health and illness are determined by social conditions.

2 There is a clear relationship between income and health, leading to the development of a social gradient.

3 Psychosocial explanations of these social variations include perceived inequality, stress, lack of control and less social connection.

4 Material explanations of the social gradient in health include reduced income and reduced access to services.

5 Political factors connect both psychosocial and material explanations in a broader causal chain.

6 Social environment includes the character of people’s social relationships and their connection with the community.

7 Social justice is concerned with providing equal opportunities for all citizens. Socio-economic status (SES) and wealth are strongly related to health, illness and mortality. These gradients may be a consequence of differences in social cohesion, stress and personal control.

8 A health psychology committed to social justice needs to orient itself towards addressing the needs of the most disadvantaged in society.