Abstract

“How should socioeconomic inequalities in health be explained” is a central question for both health inequality research and policy. In this review, I examined the development of explanatory frameworks for socioeconomic inequalities in health since the publication of the Black Report. I first summarized epidemiological debates on the relationship between socioeconomic position and health, including issues of causality, selection, and confounding, then discussed key explanatory frameworks and associated empirical evidence concerning material factors, psychosocial mechanisms, and lifecourse approaches. In addition, I presented criticisms on the conventional focus on relative explanatory power regarding the mediation of health inequalities and emphasized the importance of absolute perspectives on inequality reduction and policy focused simulation studies. The role of health behaviors—often regarded as having limited explanatory value for health inequality frameworks—was re-examined. The review further addressed fundamental cause hypothesis and structural-political frameworks to illuminate the broader social structures that generate and sustain health inequalities. Finally, I identified both the limitations and the potential of explanatory frameworks for health inequalities in informing health equity policy and called for more more policy-oriented research. This review argued that investigations into explanatory frameworks for health inequalities extend beyond identifying mechanisms and function as tools for ethical judgement and policy intervention.