Impact on social inequalities of population strategies of prevention for folate intake in women of childbearing age

Abstract

We reviewed the recent assertion that population strategies of prevention may inadvertently widen social inequalities in health. We used folate intake as a case example to examine what is known about the impact on inequalities of 2 population strategies: one agentic (public information campaign) and the other structural (mandatory fortification policy). We found some support for our hypothesis that the mandatory fortification policy was less likely than were the information campaigns to lead to worsening inequalities in health by socioeconomic status or race/ethnicity; however, conclusions were complicated by different outcome variables and different economic and political regimes in which interventions took place.

FIGURE 1

Flowchart outlining the number of published studies at each phase of the review. ^aReasons for exclusion, in order of occurrence, were: no intervention (i.e., descriptive data on population, review or commentary [39%]); not pertinent to research question (i.e., non-folate outcome variables, intervention targeted at high-risk group, no socioeconomic data provided [30%]); posttest-only design or no subgroup data provided (21%); other (e.g., simulation studies [10%]).