Social inequality in health as a political topic in Denmark in the 21st century

This study traces the evolution of the ‘(in)equality in health’ concept in parliament debates in Denmark from 1998 until 2024, exploring how the social determinants of health framework has been translated into policy discourse. We analyzed all parliament speeches employing the (in)equality in health concept between 1998 and 2024, and other significant documents of political intent during this period, including government platform papers, party programs and major political agreements. We then quantified the relative dominance of two distinct framings of health inequality by coding the parliament speeches using a large language model. We show that while health inequalities have increasingly been framed ‘broadly’ as a complex issue that notes the importance of social determinants, the practical policy issues connected with health inequalities have increasingly ‘narrowed’ in on the issue of healthcare access and quality. In a paradoxical translation of the social determinants framework, policymakers increasingly frame health inequalities as a complex phenomenon to undermine the use of legislation for structural prevention. The Danish case is illustrative of a dilemma that warrants strategic consideration among proponents of the social determinants of health framework, namely how to simultaneously broaden the policy conversation on health inequalities and prevent this broadness from being instrumentalized against action. We argue that one element of this balancing act could be to engage in more context-specific arguments for particular leverage points and to challenge the pursuit of evidence on ‘what works’ within politically defined boundaries of social change.