Academic journal article Social Alternatives

Health Inequalities in Developed Nations

Academic journal article Social Alternatives

Health Inequalities in Developed Nations

Article excerpt

Health inequalities exist to a greater or lesser extent across all developed countries. In this article we review contemporary evidence regarding the social patterning of health inequalities for a number of public health conditions. We discuss the various possible explanations for health inequalities and provide an overview of possible strategies to tackle these persistent disparities. Using an example from the UK policy arena we argue that policymakers should manage the complex nature of health inequalities by developing upstream macro-level strategies alongside more targeted interventions. We also echo calls for further research on the effectiveness of interventions aimed at tackling the intermediate and structural determinants of inequalities and warn against a return to behavioural explanations which are overly simplistic and have the potential to stigmatise already disadvantaged individuals and communities.


Despite overall improvements in health outcomes since the Second World War, health inequalities between the best and worst off in society are persistent in developed nations and in some instances are continuing to widen. As Marmot (2005) asserts, these systematic differences between and within populations should not be seen as inevitable especially since the pursuit of social justice is a key tenet of public health. Rose's seminal observation (1992) that in order to improve population health, society ought to address the 'causes of the causes' of ill health, including poor education, adverse living and working conditions, stress, and social exclusion (Marmot et al. 2008) remains pertinent in the developed world's response to entrenched patterns of inequality. In this paper we provide a summary of current evidence on the social patterning of health inequalities within and between developed nations, together with a commentary on putative explanations for why health inequalities exist. Although in developed nations the research focus has begun to shift from a description and explanation of inequalities, towards understanding what works to improve inequalities (rather than simply improving health) there is still some way to go. Against this backdrop, we will briefly examine possible approaches to tackling inequalities using an example from the UK policy arena. We will conclude with signposts for further research in the topic area.

What are Health Inequalities?

Systematic differences in health exist within and between different population groups mediated by socio-economic, ethnic, geographic, gender and age-related dimensions. As Graham and Kelly (2004) observe, these axes of differentiation often interlock and disadvantage tends to accumulate over the life course (Blane 2006). Various meanings are attributed to health inequalities. Health inequality can be defined in a purely descriptive way. For example, Kawachi and colleagues referto health inequality as 'a term used to designate differences, variations, and disparities in the health achievements of individuals and groups' (Kawchi et al. 2002, 647). More commonly though, the moral and ethical dimensions of the term are emphasised: inequalities in health are thereby 'systematic differences in health between different socio-economic groups within a society. As they are socially produced, they are potentially avoidable and widely considered unacceptable in a civilised society' (Whitehead 2007, 473). We will concentrate specifically on socioeconomic inequalities, as low socioeconomic status tends to incorporate a complex web of disadvantages such as low education, lack of power and resources, marginalisation/ exclusion, unemployment and job insecurity and poor living and working conditions (CSDH 2008).

It is well accepted that health disparities are spread across the socioeconomic strata rather than simply being confined to differences between the most and least advantaged groups. In this way the association between socioeconomic status and health is 'graded' across the spectrum (CSDH 2008, 31). …

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