Careful investigations of the political determinants of health that include the role of power in health inequalities—systematic differences in health achievements among different population groups—are increasing but remain inadequate. Historically, much of the research examining health inequalities has been influenced by biomedical perspectives and focused, as such, on ‘downstream’ factors. More recently, there has been greater recognition of more ‘distal’ and ‘upstream’ drivers of health inequalities, including the impacts of power as expressed by actors, as well as embedded in societal structures, institutions, and processes. The goal of this chapter is to examine how power has been conceptualised and analysed to date in relation to health inequalities. After reviewing the state of health inequality scholarship and the emerging interest in studying power in global health, the chapter presents varied conceptualisations of power and how they are used in the literature to understand health inequalities. The chapter highlights the particular disciplinary influences in studying power across the social sciences, including anthropology, political science, and sociology, as well as cross-cutting perspectives such as critical theory and health capability. It concludes by highlighting strengths and limitations of the existing research in this area and discussing power conceptualisations and frameworks that so far have been underused in health inequalities research. This includes potential areas for future inquiry and approaches that may expand the study of as well as action on addressing health inequality.
Advancing the study of health inequality: Fundamental causes as systems of exposure