Commentary: Socioeconomic health differentials

Abstract

The present issues of the IJE contain eight reports of socioeconomic differences in health. These articles illustrate a number of traditional themes and point to new directions. The papers come from a range of countries—Australia, Denmark, Finland, Italy, The Netherlands, Scotland and Sweden—thereby demonstrating once again1,2 the ubiquity of socioeconomic inequalities in health, at least in the rich countries of the world. These inequalities are maintained over time against a background of generally improving health. Turrell and Mathers3 report falling mortality rates combined with socioeconomic mortality differentials which widen or narrow somewhat, by age group and gender, but which remain a pervasive characteristic of the population's health. The Black Report4 analysed the combination of falling mortality and maintained differentials as a form of relative deprivation in which the health of the socially disadvantaged, in time, catches up with that of the socially advantaged, by which time however, the health of the advantaged has forged even further ahead. This basic characteristic of health inequalities provides an important clue to their causes. Only some form of social causation, whether behavioural, psychosocial or material, can account simultaneously for both parts of the phenomenon—the falling mortality and the maintained differentials. The potential importance of one form of social causation, namely socioeconomic differences in quality of medical care, is undermined by Middlekoop et al.5 who show that higher case-fatality rates are not the cause of the excess of avoidable mortality in deprived areas.

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