The Chronic Care Model (CCM) and the Social Gradient in Health
The Chronic Care Model (CCM) and the Social Gradient in Health

Summary/Abstract: Health is unevenly distributed across different social groups and the burden of chronic diseases falls disproportionately on people with lower socioeconomic status. Evidence-based health care services can mitigate the negative impact of chronic diseases at societal and individual level. However, the quality of care received by chronically-ill patients is also shaped by their socio-economic status with people from lower socio-economic groups receiving less preventive and curative care than their better-off counterparts. Several authors have argued that the social gradient in health is partly the result of a deficit in the quality of care. The Chronic Care Model (CCM) is an evidence-based policy response devoted to improving the quality of chronic care at the level of primary care. It has been implemented in several Western societies to decrease the morbidity and mortality associated with chronic diseases. The initial evaluations have shown that it is efficient and can also mitigate the social gradient in health. However, the pathways through which it acts on the social determinants of health have not been analysed in detail. In this paper we outline the materialist-structuralist and social capital pathways, described in the literature, through which social determinants shape the social gradient in health. We show that the CCM could mitigate the social inequalities in health by increasing the level of social capital at the level of health care systems. However, it does not act on the materialist and structural causes of the health inequalities and this may raise a significant concern that in the absence of other social policies it may actually increase the social inequalities in health.

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