Health Inequalities Within a Nation: a Review of Two New Theories

Abstract

What policies and values influence inequalities of health of individuals and populations? There are two main interpretations: a “materialist”, and “psycho-social” (Coburn D, 2000). It is suggested that the more a regime is neo-liberal, the bigger are the inequalities in income. The more a society is market oriented, the smaller is the trust and social-cohesion. It has been known for a long time that there is an inverse proportion between the socio-economic conditions and the state of health of a population. In the majority of industrialised countries health inequality has not been reduced despite the improvement of welfare, as reflected by, among others, life expectancy. The latest report on health inequality in England (Department of Health, London, 1998) analyses among other things the mortality rate over the last 30 years, through all causes and a series of specific causes, correlating it with six different population groups selected according to kind of work they do. Figure 1 gives the mortality rate from all causes among the male population of 20-64 years, taken from the years 197072, 1979-83 and 1991-93. The graph shows that: a) the mortality rates of the six social classes register an order that is inversely proportional to the level of social class; b) clear-cut differences are seen between professionals and technician-managers, who register the lowest mortality rates, specialised and semi-specialised, who occupy a middle position; and the non-specialised who have the highest mortality rates; c) in the space of 20 years the mortality rates diminished in all the classes, but the gap between the richer and poorer classes widened considerably; between the early 70s and 90s the mortality rates fell by 40% in classes I and II, by 30% in classes IIIN, IIIM and IV, and only by 10% in class V. These growing differences in state of health among the various social groups are also reflected in the specific causes of death: coronary disease, stroke, lung cancer, and suicide among the men, and respiratory diseases, coronary disease and lung cancer among the women. These differences in the mortality rates are reflected in the differences in life expectancy at birth between rich and poor classes: by five years among the men (75 instead of 70), by three years for the women (80 instead of 77). Similar tendencies are found in the USA where, analysing the state of health (expressed in healthy life expectancy at 30) of various population groups –whites and Afro-Americans with different levels of education –growing inequalities are registered both between the two racial groups, and within themi Crimmings E and Saito Y (2001). (figures 2 and 3).