Socioeconomic disparities in health in the US: an agenda for action
Section snippets
Inequality of income and wealth in the US
The period of economic and social expansion that began in the post-World War II era ended in the early 1970s when income gains made by Americans during the 1950s and 1960s began to erode, leading to increasing income inequality between those at the top and those at the bottom of the nation’s social hierarchy. During the 1980s, political and economic trends towards deregulation of financial markets, the globalization of capital, and social conservatism drove interest in socioeconomic equality
Attention to inequalities in health in the policy sphere
The relationship of socioeconomic inequality and health is an old — not a new — area of concern for public health policy (Amick et al., 1995). The public health community in the US, like that in the UK, has a longstanding interest in socioeconomic differences in health with advocates promoting and performing much of the work of monitoring and investigating these relationships (Krieger & Fee, 1996). Many public health researchers over the years have attempted to highlight the differences among
Actions to reduce socioeconomic disparities in health
During the past 25 years, US government intervention to improve health has come almost entirely through initiatives aimed at changing individual behavior; the public has been urged to eliminate cigarette smoking, eat more fruits and vegetables, reduce fat consumption, modify alcohol intake, and use seat belts (Marmor, Barer & Evans, 1994). The Clinton Administration has moved only recently towards more regulatory action by limiting the tobacco companies’ marketing efforts and by regulations
Creating a public policy issue: lessons from European colleagues
While member countries have varied in how health inequalities were identified as a policy issue, the European Union has identified related research as a priority area (Whitehead, 1998). Public debate on inequality in Europe is part of a long tradition supported by powerful political parties. The US has neither the collective support of a supranational body nor a major political party that is comfortable addressing inequality. There are two other major differences between the US and Europe:
What else should the US do to take action on inequalities in health?
The foregoing suggests that strategies can be grouped into three categories: those that raise the awareness level among the general public and policy makers as well as among scientists and advocates; those that address the policies at the federal, state, and local level that shape inequality; and the development of interventions that target the mediators and consequences of socioeconomic disparities in health. A first step in the US is to create a climate of unacceptability for socioeconomic
Conclusion
The renewed interest in socioeconomic disparities in health, sparked by growing inequality in an era of unprecedented prosperity, suggests that it is time to bring new thinking to this area. Although data from the UK and other Western European countries suggest that universal health care does not dissolve inequalities in outcomes, they provide instructive examples of how with will, imagination, and energy, health inequalities can be tackled at local and national levels. Recent general
Acknowledgements
This paper was first presented at the Forum, “Inequalities in Health and Health Care”, held at the University of Utah, 12 July 1996. The assistance of all participants and especially Dr Norman Waitzman is gratefully acknowledged.
References (69)
- et al.
Childhood and adult socioeconomic status as predictors of mortality in Finland
Lancet
(1994) - et al.
What can be done about inequalities in health?
The Lancet
(1991) - et al.
Setting targets to address inequalities in health
Lancet
(1998) Race and health: basic questions, emerging directions
Annals of Epidemiology
(1997)- et al.
Socioeconomic status and health: the challenge of the gradient
American Psychologist
(1994) - Anderson, N. (1997). Psychosocial, behavioral and educational factors that affect population differences in health...
Social class, life expectancy and overall mortality
The Milbank Memorial Fund Quarterly
(1967)- Atkinson, A., Rainwater, L., Smeeding, T. (1995a). Income distribution in advanced economies: evidence from the...
- et al.
Income distribution in OECD countries
(1995)