Health and Inequality, or, Why Justice is Good for Our Health

Abstract

Abstract We have known for over 150 years that an individual ‘s chances of life and death are patterned according to social class: the more affiuent and better educated people are, the longer and healthier their lives (Villerme 1840; cited in Link et al. 1998). These patterns persist even when there is universal access to health care—a finding quite surprising to those who think financial access to medical services is the primary determinant of health status. In fact, recent cross-national evidence suggests that the greater the degree of socio-economic inequality that exists within a society, the steeper the gradient of health inequality. As a result, middle-income groups in a more unequal society will have worse health than comparable or even poorer groups in a society with greater equality. Of course, we cannot infer causation from correlation, but there are plausible hypotheses about pathways which link social inequalities to health, and, even if more work remains to be done to clarify the exact mechanisms, it is not unreasonable to talk here about the social ‘determinants ‘ of health (Marmot 1999).