Table 1.

Whitehead’s principal determinants of health disparities and COPD correlates

General determinants of health disparities	Corresponding determinants for COPD
Natural biologic variation	Genetic susceptibilities
Health-damaging behavior of individuals	Smoking tobacco and/or biomass fuel use
Transient health advantage for people who adopt new behaviors first	Educated people making behavioral changes more readily than those with lower levels of education
Health-damaging behavior in which the degree of choice of lifestyles is severely restricted	People being born into and remaining in impoverished and low education settings
Exposure to unhealthy living and working conditions	Exposure to environmental (second-hand) smoke and indoor biomass fuels
Inadequate access to health care	People in lower socioeconomic status and having less health care access
Natural selection leading to the tendency for the sick to move down the social hierarchy	People with advanced COPD become disabled due to disease

Note: Data adapted from Whitehead M. The concepts and principles of equity and health. Health Promotion Int. 1991;6:217–228.¹⁶

Abbreviation: COPD, chronic obstructive pulmonary disease.