Research into the role of place in shaping inequalities in health has focused largely
on examining individual and/or localised drivers, often using a context-composition
framing. Whilst this body of work has advanced considerably our understanding of the
effects of local environments on health, and re-established an awareness of the importance
of place for health, it has done so at the expense of marginalising and minimising
the influences of macro political and economic structures on both place and health.
In this paper, we argue that: (i) we need to scale up our analysis, moving beyond
merely analysing local horizontal drivers to take wider, vertical structural factors
into account; and (ii) if we are serious about reducing place-based health inequalities,
such analysis needs be overtly linked to appropriate policy levers. Drawing on three
case studies (the US mortality disadvantage, Scotland's excess mortality, and regional
health divides in England and Germany) we outline the theoretical and empirical value
of taking a more political economy approach to understanding geographical inequalities
in health. We conclude by outlining the implications for future research and for efforts
to influence policy from 'scaling up' geographical research into health inequalities.