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Capitals and capabilities: Linking structure and agency to reduce health inequalities


  • Abel, Thomas
  • Frohlich, Katherine L.


While empirical evidence continues to show that low socio-economic position is associated with less likely chances of being in good health, our understanding of why this is so remains less than clear. In this paper we examine the theoretical foundations for a structure–agency approach to the reduction of social inequalities in health. We use Max Weber’s work on lifestyles to provide the explanation for the dualism between life chances (structure) and choice-based life conduct (agency). For explaining how the unequal distribution of material and non-material resources leads to the reproduction of unequal life chances and limitations of choice in contemporary societies, we apply Pierre Bourdieu’s theory on capital interaction and habitus. We find, however, that Bourdieu’s habitus concept is insufficient with regard to the role of agency for structural change and therefore does not readily provide for a theoretically supported move from sociological explanation to public health action. We therefore suggest Amartya Sen’s capability approach as a useful link between capital interaction theory and action to reduce social inequalities in health. This link allows for the consideration of structural conditions as well as an active role for individuals as agents in reducing these inequalities. We suggest that people’s capabilities to be active for their health be considered as a key concept in public health practice to reduce health inequalities. Examples provided from an ongoing health promotion project in Germany link our theoretical perspective to a practical experience.

Suggested Citation

  • Abel, Thomas & Frohlich, Katherine L., 2012. "Capitals and capabilities: Linking structure and agency to reduce health inequalities," Social Science & Medicine, Elsevier, vol. 74(2), pages 236-244.
  • Handle: RePEc:eee:socmed:v:74:y:2012:i:2:p:236-244
    DOI: 10.1016/j.socscimed.2011.10.028

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    References listed on IDEAS

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    3. Frohlich, Katherine L. & Potvin, Louise & Chabot, Patrick & Corin, Ellen, 2002. "A theoretical and empirical analysis of context: : neighbourhoods, smoking and youth," Social Science & Medicine, Elsevier, vol. 54(9), pages 1401-1417, May.
    4. Rütten, Alfred & Abu-Omar, Karim & Frahsa, Annika & Morgan, Antony, 2009. "Assets for policy making in health promotion: Overcoming political barriers inhibiting women in difficult life situations to access sport facilities," Social Science & Medicine, Elsevier, vol. 69(11), pages 1667-1673, December.
    5. Rütten, Alfred & Gelius, Peter, 2011. "The interplay of structure and agency in health promotion: Integrating a concept of structural change and the policy dimension into a multi-level model and applying it to health promotion principles a," Social Science & Medicine, Elsevier, vol. 73(7), pages 953-959.
    6. Ingrid Robeyns, 2005. "The Capability Approach: a theoretical survey," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 6(1), pages 93-117.
    7. Frances Stewart, 2005. "Groups and Capabilities," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 6(2), pages 185-204.
    8. Marmot, Michael & Allen, Jessica & Goldblatt, Peter, 2010. "A social movement, based on evidence, to reduce inequalities in health," Social Science & Medicine, Elsevier, vol. 71(7), pages 1254-1258, October.
    9. Abel, Thomas, 1991. "Measuring health lifestyles in a comparative analysis: Theoretical issues and empirical findings," Social Science & Medicine, Elsevier, vol. 32(8), pages 899-908, January.
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    11. Popay, Jennie & Thomas, Carol & Williams, Gareth & Bennett, Sharon & Gatrell, Anthony & Bostock, Lisa, 2003. "A proper place to live: health inequalities, agency and the normative dimensions of space," Social Science & Medicine, Elsevier, vol. 57(1), pages 55-69, July.
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    Cited by:

    1. Karen Hofmann & Dominik Schori & Thomas Abel, 2013. "Self-Reported Capabilities Among Young Male Adults in Switzerland: Translation and Psychometric Evaluation of a German, French and Italian Version of a Closed Survey Instrument," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 114(2), pages 723-738, November.
    2. Farmer, Jane & Prior, Maria & Taylor, Judy, 2012. "A theory of how rural health services contribute to community sustainability," Social Science & Medicine, Elsevier, vol. 75(10), pages 1903-1911.
    3. Langford, Rebecca & Panter-Brick, Catherine, 2013. "A health equity critique of social marketing: Where interventions have impact but insufficient reach," Social Science & Medicine, Elsevier, vol. 83(C), pages 133-141.
    4. Takagi, Daisuke & Kondo, Naoki & Takada, Misato & Hashimoto, Hideki, 2016. "Educational attainment, time preference, and health-related behaviors: A mediation analysis from the J-SHINE survey," Social Science & Medicine, Elsevier, vol. 153(C), pages 116-122.
    5. Weaver, Robert R. & Lemonde, Manon & Payman, Naghmeh & Goodman, William M., 2014. "Health capabilities and diabetes self-management: The impact of economic, social, and cultural resources," Social Science & Medicine, Elsevier, vol. 102(C), pages 58-68.
    6. Missinne, Sarah & Colman, Elien & Bracke, Piet, 2013. "Spousal influence on mammography screening: A life course perspective," Social Science & Medicine, Elsevier, vol. 98(C), pages 63-70.
    7. repec:spr:ijphth:v:63:y:2018:i:1:d:10.1007_s00038-017-1044-8 is not listed on IDEAS
    8. Missinne, Sarah & Bracke, Piet, 2015. "A cross-national comparative study on the influence of individual life course factors on mammography screening," Health Policy, Elsevier, vol. 119(6), pages 709-719.
    9. Murray, Susan F. & Akoum, Mélanie S. & Storeng, Katerini T., 2012. "Capitals diminished, denied, mustered and deployed. A qualitative longitudinal study of women's four year trajectories after acute health crisis, Burkina Faso," Social Science & Medicine, Elsevier, vol. 75(12), pages 2455-2462.
    10. Verhaeghe, Pieter-Paul & Tampubolon, Gindo, 2012. "Individual social capital, neighbourhood deprivation, and self-rated health in England," Social Science & Medicine, Elsevier, vol. 75(2), pages 349-357.
    11. Christensen, Vibeke T. & Carpiano, Richard M., 2014. "Social class differences in BMI among Danish women: Applying Cockerham's health lifestyles approach and Bourdieu's theory of lifestyle," Social Science & Medicine, Elsevier, vol. 112(C), pages 12-21.


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