Reducing health inequalities remains a challenge for policy makers across the world. Beginning from Lewin’s famous dictum that “there is nothing as practical as a good theory”, this paper begins from an appreciative discussion of ‘fundamental cause theory’, emphasizing the elegance of its theoretical encapsulation of the challenge, the relevance of its critical focus for action, and its potential to support the practical mobilisation of knowledge in generating change. Moreover, it is argued that recent developments in the theory, provide an opportunity for further theoretical development focused more clearly on the concept of power (Dickie et al. 2015). A critical focus on power as the essential element in maintaining, increasing or reducing social and economic inequalities – including health inequalities – can both enhance the coherence of the theory, and also enhance the capacity to challenge the roots of health inequalities at different levels and scales. This paper provides an initial contribution by proposing a framework to help to identify the most important sources, forms and positions of power, as well as the social spaces in which they operate. Subsequent work could usefully test, elaborate and adapt this framework, or indeed ultimately replace it with something better, to help focus actions to reduce inequalities.

中文翻译：

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健康不平等、根本原因和力量：实践良好理论


减少健康不平等仍然是世界各地政策制定者面临的挑战。本文从勒温的名言“没有什么比好的理论更实用”开始，从对“根本原因理论”的欣赏性讨论开始，强调其对挑战的理论概括的优雅性、其批判焦点的相关性。行动及其支持实际调动知识以产生变革的潜力。此外，有人认为，该理论的最新发展为更明确地关注权力概念的进一步理论发展提供了机会（Dickie et al. 2015）。重点关注权力作为维持、增加或减少社会和经济不平等（包括健康不平等）的基本要素，既可以增强理论的连贯性，也可以增强在不同层次和规模上挑战健康不平等根源的能力。本文提供了初步贡献，提出了一个框架来帮助确定最重要的权力来源、形式和地位，以及它们运作的社会空间。后续工作可以有效地测试、阐述和调整该框架，或者最终用更好的框架取代它，以帮助集中行动减少不平等。