Culture and the social context of health inequalities.

There is a great deal of recent interest and debate concerning the linkages between inequality and health cross-nationally. The U.S. National Institutes of Health recommended in 2001 that any new research on health disparities should include social and cultural systems as units of analysis. Nevertheless, many public health interventions and policies continue to decontextualize risk factors from the social environment. Exposures to social and health inequalities probably vary as a consequence of different cultural contexts. To identify the processes that cause social and health inequalities, it is important to understand culture's influence. Navarro's research on political institutions and inequality illustrates the role of cultural context, although indirectly. Policies reflect cultural values because politicians typically translate their constituents' dominant values into policy. Political systems and structural inequality are institutionalized manifestations of cultural differences that intervene between dominant cultural dimensions at the societal level and health. The authors present a theoretical framework that combines constructs from sociological theory and cross-cultural psychology to identify potential pathways leading from culture and social structure to social and health inequalities. Only when all levels are taken into consideration is it possible to come up with effective, sustainable policies and interventions.