A Health Strategy on the Reduction of Inequalities: Not a Utopian Fantasy

          As social inequalities in health in the U.S. and international evidence continue to increase, disparities in income and wealth widened the gap making social class as a key determinant of population health. The gap is widening between upper-middle-class Americans and middle class Americans. Health and longevity are determined by the access of advances in medicine and disease prevention. These benefits are disproportionately delivered to individuals who have more education, connections, money, and good jobs. They are the ones in the best position to learn new information early, modify their behavior, take advantage of the latest treatments and have the cost covered by insurance. Since 1911, mortality statistics in Britain have consistently shown an inverse relation between measures of socio-economic status and mortality. While social class has been a less popular topic in the United States, this has been a trend in Europe since George III. Socio-economic disparities in mortality statistics have been increasing both in the U.S. and Britain, despite an overall decline in death rates. It is almost universally the case that the social class, the combination of income, education, occupation and wealth, plays a pivotal role in defining an individual’s ability to change their lives and shaped the odds of getting better. In Europe, people in lower economic class have more morbidity and disability and have shorter lives. Like the U.S., European countries’ immigrant workers and long term unemployed are increasingly isolated from the rest of society.  It is not a Utopian fantasy to develop a health strategy that include reduction in inequalities. Health inequalities vary between countries, thereby it is not a fixed magnitude. Marmot et al. study (1997) stated “material deprivation plays an important role in generating inequalities in health. At a threshold above absolute deprivation, other factors may be more important in generating relative differences in health. If we are to appeal to the concept of relative deprivation, this implies the operation of psycho-social factors related to the position in the hierarchy.”

         There are four major models used to describe social class in health. Life-course, psycho-social, and materialist model are the models that could best explain the relationship of social class and the health outcome of early medical care. Life-course model explains social class inequalities rooted from what happened to a child in-utero and early childhood. Poor home condition overtime is the predominant causation of occupational disadvantage. Psycho-social model explains the effect of social inequality to body chemistry. Stressful social circumstances produce emotional responses which bring about biological changes, thereby increasing the risk of heart disease. Plethora of socio-economic challenges tends to discourage individual to seek early medical intervention.  Materialist model pertains to economic factors in relation to the individual’s environment, such as air-pollution and substandard housing conditions. Studies show a higher rate of childhood respiratory disease in damp housing. Bartley & Blane (2008) noted the fourth model-behavioral model in reference to the Whitehall 1967 study.  The Whitehall study found that differences in health behavior explain only one-third of social class differences in mortality. Evaluations of interventions that seek to change health behaviors have rarely found clear-cut improvements in health.


Poverty, Ill Health and Health Care Expenditure – Scribd. (n.d.). Retrieved from http://www.scribd.com/doc/42351361/Poverty-Ill-Health-and-Health-Care-Expenditure

Inequalities in the distribution of health and health care … (n.d.). Retrieved from http://healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-ec


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