[Theoretical and Practical Challenges of Proportionate Universalism: a ReviewAnálise Dos Desafios Teóricos E Práticos De Universalismo Proporcional]

Overview

Journal Rev Panam Salud Publica

Specialty Public Health

Date 2021 Oct 27

PMID 34703455

Citations 2

Authors

Florence Francis-Oliviero

Linda Cambon

Jerome Wittwer

Michael Marmot

Francois Alla

Affiliations

Soon will be listed here.

Abstract

Objective: In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues.

Methods: We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases.

Results: This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs.

Conclusion: This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.

Citing Articles

Coates A, Castro A, Marmot M, Mujica O, Eijkemans G, Victora C Rev Panam Salud Publica. 2021; 45:e99.

PMID: 34484312 PMC: 8407600. DOI: 10.26633/RPSP.2021.99.

Coates A, Castro A, Marmot M, Mujica O, Eijkemans G, Victora C Rev Panam Salud Publica. 2020; 44:e167.

PMID: 33337445 PMC: 7737846. DOI: 10.26633/RPSP.2020.167.

References

Darquy S, Moutel G, Jullian O, Barre S, Duchange N . Towards equity in organised cancer screening: the case of cervical cancer screening in France. BMC Womens Health. 2018; 18(1):192. PMC: 6258288. DOI: 10.1186/s12905-018-0683-0. View

Moutel G, Duchange N, Lievre A, Orgerie M, Jullian O, Sancho-Garnier H . Low participation in organized colorectal cancer screening in France: underlying ethical issues. Eur J Cancer Prev. 2017; 28(1):27-32. DOI: 10.1097/CEJ.0000000000000417. View

Cowley S, Whittaker K, Malone M, Donetto S, Grigulis A, Maben J . Why health visiting? Examining the potential public health benefits from health visiting practice within a universal service: a narrative review of the literature. Int J Nurs Stud. 2014; 52(1):465-80. DOI: 10.1016/j.ijnurstu.2014.07.013. View

Brady D, Burroway R . Targeting, universalism, and single-mother poverty: a multilevel analysis across 18 affluent democracies. Demography. 2012; 49(2):719-46. DOI: 10.1007/s13524-012-0094-z. View

Briancon S, Legrand K, Muller L, Langlois J, Saez L, Spitz E . Effectiveness of a socially adapted intervention in reducing social inequalities in adolescence weight. The PRALIMAP-INÈS school-based mixed trial. Int J Obes (Lond). 2020; 44(4):895-907. DOI: 10.1038/s41366-020-0520-z. View

Shankaran V, McKoy J, Dandade N, Nonzee N, Tigue C, Bennett C . Costs and cost-effectiveness of a low-intensity patient-directed intervention to promote colorectal cancer screening. J Clin Oncol. 2007; 25(33):5248-53. DOI: 10.1200/JCO.2007.13.4098. View

Bywater T, Berry V, Blower S, Cohen J, Gridley N, Kiernan K . Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE): a study protocol of a community-based randomised controlled trial with process and economic evaluations of the incredible years infant and toddler parenting programmes,.... BMJ Open. 2018; 8(12):e026906. PMC: 6303737. DOI: 10.1136/bmjopen-2018-026906. View

Brewster L, Sherriff A, MacPherson L . Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study. BMC Public Health. 2013; 13:778. PMC: 3765943. DOI: 10.1186/1471-2458-13-778. View

Guillaume E, Dejardin O, Bouvier V, De Mil R, Berchi C, Pornet C . Patient navigation to reduce social inequalities in colorectal cancer screening participation: A cluster randomized controlled trial. Prev Med. 2017; 103:76-83. DOI: 10.1016/j.ypmed.2017.08.012. View

10.

Cookson R, Drummond M, Weatherly H . Explicit incorporation of equity considerations into economic evaluation of public health interventions. Health Econ Policy Law. 2009; 4(Pt 2):231-45. DOI: 10.1017/S1744133109004903. View

11.

Maharaj V, Rahman F, Adamson L . Tackling child health inequalities due to deprivation: using health equity audit to improve and monitor access to a community paediatric service. Child Care Health Dev. 2012; 40(2):223-30. DOI: 10.1111/cch.12011. View

12.

Rice P . Plus ça change, plus c'est la même chose: a Review of Recent Alcohol Policy Developments in Europe. Alcohol Alcohol. 2019; 54(2):123-127. DOI: 10.1093/alcalc/agz013. View

13.

Wiseman V, Thabrany H, Asante A, Haemmerli M, Kosen S, Gilson L . An evaluation of health systems equity in Indonesia: study protocol. Int J Equity Health. 2018; 17(1):138. PMC: 6134712. DOI: 10.1186/s12939-018-0822-0. View

14.

Morrison J, Pikhart H, Ruiz M, Goldblatt P . Systematic review of parenting interventions in European countries aiming to reduce social inequalities in children's health and development. BMC Public Health. 2014; 14:1040. PMC: 4203958. DOI: 10.1186/1471-2458-14-1040. View

15.

Chandra A, Vogl T . Rising up with shoe leather? A comment on Fair Society, Healthy Lives (the Marmot Review). Soc Sci Med. 2010; 71(7):1227-1230. DOI: 10.1016/j.socscimed.2010.07.006. View

16.

Burstrom B, Marttila A, Kulane A, Lindberg L, Burstrom K . Practising proportionate universalism - a study protocol of an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden. BMC Health Serv Res. 2017; 17(1):91. PMC: 5273844. DOI: 10.1186/s12913-017-2038-1. View

17.

Asaria M, Griffin S, Cookson R, Whyte S, Tappenden P . Distributional cost-effectiveness analysis of health care programmes--a methodological case study of the UK Bowel Cancer Screening Programme. Health Econ. 2014; 24(6):742-54. DOI: 10.1002/hec.3058. View

18.

Marmot M . Social determinants of health inequalities. Lancet. 2005; 365(9464):1099-104. DOI: 10.1016/S0140-6736(05)71146-6. View

19.

Colquhoun H, Levac D, OBrien K, Straus S, Tricco A, Perrier L . Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014; 67(12):1291-4. DOI: 10.1016/j.jclinepi.2014.03.013. View

20.

Legrand K, Lecomte E, Langlois J, Muller L, Saez L, Quinet M . Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis. Contemp Clin Trials Commun. 2018; 7:141-157. PMC: 5898577. DOI: 10.1016/j.conctc.2017.05.010. View