Social Determinants in very poor ruralities

Usual measures of position on the social gradient are useful for international, national and even regional comparisons and contribute to stimulate countries to introduce policies to reduce health inequalities. However, in certain context, including very poor ruralities, where the health status of individuals is highly variable, classical social position measures such as income, expenditure, education and occupation are mostly irrelevant.


This project identified health-relevant indicators of social position, comparing three different regional cases (one from sub-Saharan Africa, one from Latin-America, and one from South East Asia) in order to differentiate those that are context specific to those that are not context specific. These relevant indicators will next be used in research to illuminate how they relate to variations in health.


The project used the following intersecting methods:

  • Three local - expert reference groups constituted of people having an in-depth and complementary knowledge of the above mentioned regions.

  • A literature review of related research fields which will contribute to explore what other disciplines such as development studies, rural sociology, social geography, social anthropology and social epidemiology offer in terms of indicators that determine the social position of individuals and groups.

  • Field visits which included meetings with local expert reference groups and the collection of qualitative data.

  • Data analysis including existing survey data and qualitative data collected during the field visits.


A final report presents the conclusions of these findings and suggests initial recommendations for action notably contributing to develop policy to address health inequalities in these regions.


Related articles & interesting references

  • Bull T., Duah-Owusu M., Autry Andvik C. ‘My Happiest Moment is when I have Food in Stock': poor Women in Northern Ghana Talking about their Happiness. (2010) International Journal of Mental Health Promotion Vol 12 (2): 24-31

  • Mittelmark M. B. The Social Gradient in Health in Very Poor Rural Areas: Insights from Southeast Asia. (2009/2010) Health for the Millions C/o.Voluntary Health Association of India 22-26