Elsevier

Social Science & Medicine

Volume 51, Issue 11, 1 December 2000, Pages 1627-1638
Social Science & Medicine

Socioeconomic disparities in health in the US: an agenda for action

https://doi.org/10.1016/S0277-9536(00)00058-7Get rights and content

Abstract

Inequality of income and wealth in the US has been growing rapidly since 1972. Evidence of socioeconomic effects on health is documented for many endpoints, and there is evidence that socioeconomic disparities in health are increasing. In Europe, equity in health and health care is a target of the World Health Organization, and has led to a variety of activities to reduce socioeconomic disparities in morbidity and mortality. In the US, activities in the public and private sectors have increased in recent years but attention, especially among the public-at-large in addition to elites, needs to be shifted to socioeconomic disparities. The paper suggests action strategies drawn from the European experience and other US efforts to place public health priorities on the policy agenda. A first step is to create a climate of unacceptability for socioeconomic disparities in health. Recommended activities include improvement and utilization of existing data; dissemination to broad audiences; building on existing initiatives; creating multi-sectoral alliances; formation of state and community task forces; attention to human capital as well as social justice issues; creative use of media; attraction of new funders; and implementation of quantitative targets.

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)

  • D.J.P. Barker

    Mothers, babies and health in later life

    (1998)
  • L.F. Berkman et al.

    The measurement of social class in health studies: old measures and new formulations

  • Bradsher, K. (1995). Gap in wealth in US called widest in West. New York Times, 17 April,...
  • P. Braveman

    Equity in health and health care: A WHO/SIDA initiative

    (1996)
  • M. Cancian et al.

    The changing contributions of men and women to the level and distribution of family income, 1968–88

  • S. Danziger et al.

    America unequal

    (1995)
  • G. Davey Smith et al.

    Socioeconomic differentials in wealth and health: Widening inequalities in health — the legacy of the Thatcher years

    BMJ

    (1993)
  • G.J. Duncan

    Income dynamics and health

    International Journal of Health Services

    (1996)
  • G.J. Duncan et al.

    W(h)ither the middle class? A dynamic view

  • I.T. Elo et al.

    Effects of early life conditions on adult mortality: A review

    Population Index

    (1992)
  • A.M. Guest et al.

    The ecology of race and socioeconomic distress: Infant and working-age mortality in Chicago

    Demography

    (1998)
  • A. Haines et al.

    Working together to reduce poverty’s damage: Doctors fought nuclear weapons, now they can fight poverty (editorial)

    BMJ

    (1997)
  • H. Hemingway et al.

    The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: the Whitehall II study

    American Journal of Public Health

    (1997)
  • G.A. Kaplan et al.

    Inequality in income and mortality in the United States: analysis of mortality and potential pathways

    British Medical Journal

    (1996)
  • G.A. Kaplan

    People and places: contrasting perspectives on the association between social class and health

    International Journal of Health Services

    (1996)
  • R. Karasek et al.

    Healthy Work: Stress, Productivity and the Reconstruction of Working Life

    (1990)
  • B.P. Kennedy et al.

    Income distribution and mortality: cross-sectional ecological study of the Robin Hood index in the United States

    British Medical Journal

    (1996)
  • N. Krieger et al.

    Can we monitor socioeconomic inequalities in health? A survey of US health departments' data collection and reporting practices

    Public Health Reports

    (1997)
  • N. Krieger et al.

    Measuring social inequalities in health in the United States: A historical review, 1900–1950

    International Journal of Health Services

    (1996)
  • N. Krieger et al.

    Accounting for the public’s health: an introduction to selected papers from a U.S. conference on “Measuring Social Inequalities in Health.”

    International Journal of Health Services

    (1996)
  • N. Krieger et al.

    Measuring social class in US public health research: concepts, methodologies, and guidelines

    Annual Review of Public Health

    (1997)
  • Cited by (0)

    View full text