Skip to Main Content
Have library access? Log in through your library
Social inequality and public health

Social inequality and public health

Edited by Salvatore J. Babones
Copyright Date: 2009
  • Cite this Item
  • Book Info
    Social inequality and public health
    Book Description:

    Public health in the early 21st century increasingly considers how social inequalities impact on individual health, moving away from the focus on how disease relates to the individual person. This 'new public health' identifies how social, economic and political factors affect the level and distribution of individual health, through their effects on individual behaviours, the social groups people belong to, the character of relationships to others and the characteristics of the societies in which people live. The rising social inequalities that can be seen in nearly every country in the world today present not just a moral danger, but a mortal danger as well. Social inequality and public health brings together the latest research findings from some of the most respected medical and social scientists in the world. It surveys four pathways to understanding the social determinants of health: differences in individual health behaviours; group advantage and disadvantage; psychosocial factors in individual health; and healthy and unhealthy societies, shedding light on the costs and consequences of today's high-inequality social models. This exciting book brings together leaders in the field discussing their latest research and is a must-read for anyone interested in public health and social inequalities internationally.

    eISBN: 978-1-84742-322-1
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Table of Contents
    (pp. iii-iv)
  3. List of figures, tables, maps and boxes
    (pp. v-vi)
  4. Preface
    (pp. vii-viii)
    Salvatore J. Babones
  5. Notes on contributors
    (pp. ix-xii)
  6. ONE Introduction
    (pp. 1-6)
    Salvatore J. Babones

    In 1916, epidemiologist Hibbert Winslow Hill published an influential volume onThe new public healthof his day, which was increasingly focused on the individual-level biological determinants of health. In Hill’s synopsis, ‘the old public health was concerned with the environment; the new is concerned with the individual’ (Hill, 1916, p 8). The individual-level orientation of this ‘new public health’ was explicitly formulated in reaction to the ‘old public health’ of the 19th century, in which founding epidemiologists like John Snow had uncovered the environmental origins of major diseases like cholera. As the 20th century dawned, advances in cell biology...

  7. Pathway 1: Differences in individual health behaviours

    • TWO The role of time preference and perspective in socioeconomic inequalities in health-related behaviours
      (pp. 9-24)
      Jean Adams

      Pervasive socioeconomic inequalities in health and disease have been consistently reported within and between populations (Mackenbach et al, 1997; Acheson, 1998). While epidemiologists are adept at describing these relationships, evidence for interventions that can achieve whole-scale reduction of socioeconomic inequalities in health remains scarce (Arblaster et al, 1996; Gunning-Schepers and Gepkens, 1996; Alvarez-Dardet and Ashton, 2005). Socioeconomic differences in behaviours that influence health, such as smoking, diet and uptake of screening and vaccination programmes, play an important role in overall inequalities in health (Marmot et al, 1997), but there remains little understanding of why socioeconomic patterning of these behaviours persists...

    • THREE Examination of the built environment and prevalence of obesity: neighbourhood characteristics, food purchasing venues, green space and distribution of Body Mass Index
      (pp. 25-44)
      Tamara Dubowitz, Theresa L. Osypuk and Kristen Kurland

      Obesity has become an epidemic in the US and it is poised to become the nation’s leading health problem. Sixty-five per cent of the US population is either overweight or obese. However, the condition is not evenly distributed along racial, socioeconomic or gender lines. The prevalence of adult overweight and obesity is higher among Hispanics and African Americans than among non-Hispanic white people (Flegal et al, 2002). African Americans have the highest obesity rates and have also experienced the steepest increases in Body Mass Index (BMI) over time (McTigue et al, 2002; Schoenborn et al, 2002; Denney, et al, 2004)....

    • FOUR Reinventing healthy and sustainable communities: reconnecting public health and urban planning
      (pp. 45-62)
      Mary E. Northridge, Elliott D. Sclar, Annie Feighery, Maryann Z. Fiebach and Emily Karpel Kurtz

      The world has an unprecedented opportunity to improve the health and lives of billions of people by adopting practical approaches to meeting the United Nations (UN) Millennium Development Goals. The Task Force on Improving the Lives of Slum Dwellers has identified strategies for managing a projected near doubling of the urban population over the next three decades. We contend that this challenge can be met if local authorities and national governments work closely with the urban poor through open and participatory processes that give them a voice in decisions about the infrastructure and public services that affect their lives. Building...

  8. Pathway 2: Group advantage and disadvantage

    • FIVE How and why do interventions that increase health overall widen inequalities within populations?
      (pp. 65-82)
      Martin White, Jean Adams and Peter Heywood

      Health inequalities between groups within populations defined by place of residence, race, ethnicity or culture, occupation, gender, religion, age, education, income or other measure of socioeconomic position (SEP) are widely observed (Marmot et al, 1978; Townsend and Davidson, 1982; Charlton and White, 1995) and, in many contexts, growing (Adams et al, 2006). Reducing health inequalities has become an important objective of governments worldwide (US Department of Health and Human Services, 2000; Department of Health, 2004). However, evidence for strategies to reduce health inequalities is limited and systematic reviews have failed to offer substantive analyses or contribute to theory (Arblaster et...

    • SIX The metaphor of the miner’s canary and black–white disparities in health: a review of intergenerational socioeconomic factors and perinatal outcomes
      (pp. 83-96)
      Debbie Barrington

      In the bookThe miner’s canary, Lani Guinier and Gerald Torres (2002) use the metaphor of the miner’s canary to describe the predicament of racially marginalised people in the US. Years ago, a canary would be taken into the mines to alert miners to dangerous atmospheric conditions. Since the canary’s more sensitive respiratory system would cause it to collapse from any poisonous gases long before humans could be affected, the canary’s distress was a signal for an immediate departure from the mine. Guinier and Torres (2002, p 12) write that:

      [T]he miner’s canary metaphor helps us to understand why and...

    • SEVEN From adversary to ally: the evolution of non-governmental organisations in the context of health reform in Santiago and Montevideo
      (pp. 97-112)
      Javier Pereira Bruno and Ronald Angel

      The non-governmental organisation (NGO), which traces the beginning of its modern mission to the need to rebuild a Europe ravaged by the Second World War, represents an organisational form that is rapidly evolving in response to complex global, national and local forces, and that at the same time is redefining the role of the state and of civil society in the provision of social services. Despite the relatively recent global and large-scale proliferation of the NGO phenomenon, they have existed for centuries. Their founding philosophy is perhaps best embodied in the religious requirement that the pious believer practise good works...

  9. Pathway 3: Psychosocial factors in individual health

    • EIGHT Health inequalities and the role of psychosocial work factors: the Whitehall II Study
      (pp. 115-130)
      Eric Brunner

      Despite the improvements in average income, life continues to be a struggle for many people. Although Marx has not proved to be the inspiration for vibrant social development, his concept of alienation resonates today. As social commentator Terry Eagleton has observed, alienation is embedded in the post-soviet, market-driven world (Eagleton, 2003). Culture and values are now important commodities, not so much in the marketplace, as the very fabric of the marketplace. Without wealth and money it is impossible to participate in the range of activities that the mass media constantly reflect to us: prestige is all too present in our...

    • NINE Inequality, psychosocial health and societal health: a model of inter-group conflict
      (pp. 131-142)
      Siddharth Chandra

      The aim of this chapter is to present a model that links inequality with psychosocial health, and psychosocial health with group violence. In the process, I explore linkages between identity, inequality and the behaviour of groups using models and concepts from psychology, politics, sociology, economics and demography. At a variety of levels, these linkages can be thought of as driving a major public health outcome, namely violence.

      Over the past two decades, a large literature has developed, which identifies violence as a public health problem. This literature has emphasised individual acts of violence that have a relatively high degree of...

    • TEN The social epidemiology of population health during the time of transition from communism in Central and Eastern Europe
      (pp. 143-156)
      Arjumand Siddiqi, Martin Bobak and Clyde Hertzman

      The present study offers a social epidemiological perspective on population health in Central and Eastern Europe (CEE) following the major societal transition there in the late 1980s and early 1990s. During this time, in much of CEE, a change of guard occurred from Soviet-style communist regimes to equally ‘fundamentalist’ capitalist (free-market) economic approaches; a phenomenon described as ‘shock therapy’ that was marked by a breakdown in the trade relationships among the Warsaw Pact countries, rapid economic decline and high rates of unemployment and inflation (Sachs, 1994; Brainerd, 1997; Klein and Pomer, 2001).

      This was also a period of rapid political...

  10. Pathway 4: Healthy and unhealthy societies

    • ELEVEN The impact of inequality: empirical evidence
      (pp. 159-168)
      Richard Wilkinson

      Attitudes to inequality are perhaps at the core of the political divide between Left and Right. But what inequality does or does not do to us has remained largely a matter of conjecture and personal opinion. Now, however, that is changing. For the first time, we have comparable measures of the scale of inequality in different societies and can actually see what effect it has. Many people believe that inequality is socially divisive and adds to the problems associated with relative deprivation. New empirical evidence not only confirms that this is true, it also suggests that inequality is the most...

    • TWELVE ‘Public goods’, metropolitan inequality and population health in comparative perspective: policy and theory
      (pp. 169-184)
      James R. Dunn and Nancy A. Ross

      There is no such thing as society: there are individual men and women, and there are families. (Margaret Thatcher, 1987,

      Margaret Thatcher’s infamous words suggest a declining capacity to conceptualise and articulate notions of the public good in affluent societies. Such a lack of collective imagery is at odds with recent research investigating the relationship between societal income distribution and population health in industrialised countries. This research suggests that societies (national and subnational jurisdictions) with more egalitarian income distributions have better average health status. It is already well established that for individuals in industrialised countries, greater social status (however...

    • THIRTEEN Inequality and health: models for moving from science to policy
      (pp. 185-198)
      Salvatore J. Babones

      More equal societies exhibit longer life expectancy than less equal societies. This implies that societies could potentially become healthier through reductions in inequality, but the micro-level mechanisms through which this could be accomplished are not obvious. Nonetheless, it is clear that there exists some sort of relationship between inequality and health, and that it is both scientifically and politically important. Given this, what is the best way to move towards policy implications? Getting from health science to health policy requires first that the statistical model connecting income inequality to population health be translated into a conceptual model that traces out...

  11. Conclusions:: Public understanding of the new public health

    • FOURTEEN Promoting public understanding of population health
      (pp. 201-214)
      Stephen Bezruchka

      This chapter addresses the need to apply the information and perspectives described in this volume to improve health. The basic premise of the book is that individual behaviours are less important for producing health than are structures that underlie inequalities in a society. This concept may be thought of as a scientific revolution or new paradigm in our thinking about health, and as with most paradigm shifts, is resisted by both scientists and the general population. Putting these ideas into action will require promoting a broader public understanding and acceptance of the basic determinants of health. The subject of this...

    • FIFTEEN Health, inequalities and mobilisation: human rights and the Millennium Development Goals
      (pp. 215-230)
      Paul Nelson

      Rapid, sustained progress on global health and development would require the mobilisation of governments and the financial resources they command, and of social movements and non-governmental organisations (NGOs), whose ability to mobilise social energy and action is essential to overcoming barriers that exclude many poor and socially marginalised groups from the benefits of global growth. The international aid social system – donor agencies, contractors, NGOs and community-based organisations – is often described as development ‘partnerships’ capable of concerted cooperation for the common good. But donor governments, NGOs and social movements in the poor countries are often at odds over trade,...

    • SIXTEEN What the public needs to know about social inequality and public health
      (pp. 231-236)
      Salvatore J. Babones

      As fate would have it, the chain of events that eventually led to the publication of this book had its genesis in a chance encounter on the fringes of a homeland security meeting focused on responses to international terrorism. I had reported to the meeting that, despite reasonable-sounding suggestions to the contrary, social inequality did not really seem to be associated in any way with international terrorism. First of all, most international terrorism originates in middle-income countries, not poor countries. The people in those countries who become international terrorists are generally among the better off in their countries. On top...

  12. Index
    (pp. 237-243)
  13. Back Matter
    (pp. 244-244)