Effects of school health promotion on social inequalities. A systematic review

Background. According to the inverse equity hypothesis public health interventions are usually more effective among privileged social groups. The objective of this article is to find out whether this assumption also applies to health promotion in schools. Method. A systematic review provided evidence to assess, if relevant interventions tended to have an increasing effect on social inequality. Two reviewers independently screened the results of comprehensive database queries. Based on pre-defined inclusion criteria 25 publications were selected. Results. Most interventions concerning nutrition and physical activity resulted in an increased gender inequality, but this hardly applies to ethnic and socioeconomic inequalities. Regarding dental health, no intervention that increased social inequality was found. As far as mental health and substance use are concerned interventions had mixed effects depending on the form of intervention and outcome measures. Conclusion. The inverse equity hypothesis can only partly be applied to health promotion in schools. The use of certain kinds of intervention can apparently help to reduce the risk of increasing inequalities in health among students.