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The Inequalities in Health Debate: A Critical Review of the Issues*

Published online by Cambridge University Press:  20 January 2009

Roy Carr-Hill
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Abstract

There has been an ongoing dispute about inequalities in health ever since the suppressed publication of the Black Report in 1980. It has recently been given a new edge by three publications: the proceedings of an SSRC Workshop held in November 1983 and the Registrar General's Decennial Supplement for 1979–1983, and another half-suppressed report, this time from Health Education Council. The first and third broadly claim that inequalities in health are widening; the second that they are irrelevant. This paper reviews the debate since 1980 around the issues of measurement (how to assess differences between social groups and how to compare across time) and the four kinds of explanation examined by the Black Report. The concluding discussion emphasises the essentially political nature of the debate over the ‘trends’ but concludes that, whilst most agree on the importance of materialist/structuralist variables, there are differences in the policy implications of the different explanatory positions. However, on the whole these will not be resolved by ‘further research’: the time is long overdue for a redistribution of resources to eradicate poverty.

Type
Survey Article
Information
Journal of Social Policy , Volume 16 , Issue 4 , October 1987 , pp. 509 - 542
Copyright
Copyright © Cambridge University Press 1987

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References

REFERENCES

Alderson, M.R. (1986), ‘Lies, damned lies and suppressed statistics’, British Medical Journal, 293, 23.8.86, p.503.CrossRefGoogle Scholar
Barker, D.J.P. and Osmond, C. (1987), ‘Inequalities in health in Britain: specific explanations in three Lancashire towns’, British Medical Journal. 294, pp.749–752.Google Scholar
Bartley, M. (1986), Letter to New Society, 26.9.86.Google Scholar
Blane, D. (1987), ‘The meaning of social class differences in health: people's experiences of risk factors’, Radical Community Medicine, 29, Spring, 1987, pp.31–37.Google Scholar
Blaxter, M. (1981), The Health of the Children, Heinemann, London.Google Scholar
Blaxter, M. (1986). ‘Longitudinal studies in Britain relevant to inequalities in health’, in Wilkinson, R.G. (ed.), Class and Health: Research and Longitudinal Data, Tavistock, London.Google Scholar
Blaxter, M. (1986a), ‘A comparison of measures of inequality in morbidity’, presented to ESF/ESRC Workshop on Inequalities in Health, City University, London, June 1986, appearing in Fox, A.J. (ed.), Inequalities in Health in European Countries, Cower for the European Science Foundation, Farnborough.Google Scholar
Carr-Hill, R.A. (1984), ‘Inequalities in health: deprivation ór distribution’, Radical Community Medicine, 19, 38–40.Google Scholar
Carr-Hill, R.A. (1985). ‘Whither (research on) unemployment’, in Roberts, B., Gallie, D. and Finnegan, R. (eds). New Approaches to Economic Life, Manchester University Press, Manchester.Google Scholar
Carr-Hill, R.A. (1985a), ‘The political and scientific debate in inequalities in health in the UK’, paper presented to Franco-British Workshop on Inequalities in Health 1985. Available from author, Centre for Health Economics, University of York.Google Scholar
Carr-Hill, R.A. (1987a), ‘Time trends in inequalities in health’, The Journal of Biosocial Science, to appear, available from author, Centre for Health Economics, University of York.Google Scholar
Carr-Hill, R.A., Hardman, G. and Russell, I.T. (1987), ‘Can variations in avoidable mortality be attributed to variation in health care resources’, The Lancet, 4.4.87.Google Scholar
Cochrane, A.L., Leger, A.S.St. and Moore, F. (1978), ‘Health Service “input” and mortality “output” in developed countries’, Journal of Epidemiology and Community Health, 32, 200–205.CrossRefGoogle Scholar
Culyer, A.J. (1983). Health Indicators: An International Study for the European Science Foundation, Martin Robinson, Oxford.Google Scholar
DHSS (1980), Inequalities in Health: the Black Report, HMSO, London.Google Scholar
DHSS (1985), Review of Social Security, HMSO, London.Google Scholar
Desplanques, G. (1985), ‘Mortality and Activity: some aspects’, paper to Second European Science Foundation Workshop on Inequalities in Health, City University, London.Google Scholar
Economic Planning Agency, White Paper on National Life, Tokyo, Japan.Google Scholar
Fox, A.J. and Goldblatt, P.O. (1982), Socio-demographic Mortality Differentials: Longitudinal Study 1971–75, OPCS, Series LS No. 1, HMSO, London.Google Scholar
Gaffey, W.R. (1976), ‘A Critique of the Standardised Mortality Ratio’, Journal of Occupational Medicine, 18, 157–160.CrossRefGoogle Scholar
Gudex, C. (1986), QALYs and their use by the Health Service, Discussion Paper 20, Centre for Health Economics, University of York.Google Scholar
Hakim, C. (1982), ‘The social consequences of high unemployment’, Journal of Social Policy, 11: 4, 433–467.CrossRefGoogle ScholarPubMed
Hansluwka, H., Porapakkham, P. and Prasartkul, P. (1986), New Developments in the Analysis of Mortality and the Cause of Death, World Health Organisation, Geneva.Google Scholar
Hart, N. (1986). ‘Inequalities in health: the individual versus the environment’, Journal of the Royal Statistical Society, Series A (General) 149, 3, 228–246.Google Scholar
Hart, N. (1987), ‘Class, Health and Survival: the gap widens’, Radical Community Medicine, 29, Spring 1987, pp.10–17.Google Scholar
Illich, I. (1975), Medical Nemesis: the Expropriation of Health, Calde and Boyan, London and New York.Google Scholar
Illsley, R. (1955), ‘Social Class and selection and class differences in relation to stillbirths and infant deaths’, British Medical Journal ii, 1520.Google Scholar
Illsey, R. (1983), ‘Social mobility, selection and the production of inequalities’, presented at SSRC Workshop on Research Priorities in Inequalities in Health, 20–21 11, Royal Society of Medicine, London.Google Scholar
Illsley, R. (1986), ‘Occupational class, selection and the production of inequalities in health’, Quarterly Journal of Social Affairs, 2 (2), 151–165.Google Scholar
Illsley, R. (1987), ‘Occupational class, selection and inequalities in health: rejoinder to Richard Wilkinson’, Quarterly Journal of Social Affairs, 06.Google Scholar
Illsley, R. and Mullen, K. (1985), ‘The health needs of disadvantaged client groups’, Oxford Textbook of Public Health, Vol. 4, Oxford University Press, Oxford.Google Scholar
Inskip, H. et al. (1983), ‘Methods for age-adjustment of rates’, Statistics in Medicine, 2, 455–466.CrossRefGoogle ScholarPubMed
Jenkin, P. (1980), Forword to Black Report, HMSO, London.Google Scholar
Jones, I.L. and Cameron, D. (1984), ‘Social Class—an embarrassment to epidemiology’, Community Medicine, 6, 37–46.Google Scholar
Klein, R. (1985), ‘Discussion to Public Controversies and Scientific Evidence’, reported in Royal Statistical Society News and Notes, 12, 6, 02 1986.Google Scholar
Knight, I. (1984), The Heights and Weights of Adults in Great Britain, HMSO, London.Google Scholar
Knox, P.L. (1979), ‘The accessibility of primary care to urban patients: a geographical analysis’, Journal of Royal College of General Practitioners, 29 (220), 160–8.Google ScholarPubMed
Koskinen, S. (1985), ‘Time trends in cause-specific mortality by occupational class in England and Wales’, paper to International Union for the Scientific Study of Population Twentieth General Conference, Florence.Google Scholar
Lavers, R.J. and Carr-Hill, R.A. (1985), ‘Staying alive in 1985’, Radical Statistics Newsletter, 36, British Society for Social Responsibility in Science, London.Google Scholar
Lawrance, J. (1986a), ‘Britain's poor face bigger death risk’, New Society, 11.7.86, p.5.Google Scholar
Lawrance, J. (1986b), ‘What death penalty do the poor pay?’ New Society, 12.9.86, p.20.Google Scholar
Leete, R. and Fox, A.J. (1977), ‘Registrar General's Social Classes: origins and clues’, Population Trends 8, Summer 1977, pp.1–7.Google Scholar
Grand, J. Le (1985), Inequalities in Health: the Human Capital Approach, Welfare State Programme Pamphlet No. 1, London School of Economics, London.Google Scholar
Grand, J. Le (1986), ‘Inequalities in health and health care: a research agenda’, in Wilkinson, R.G. (ed.). Class and Health, ESRC, Tavistock, London.Google Scholar
Grand, J. Le and Illsley, R. (1986), ‘The measurement of inequality in health’, paper presented to British Association for the Advancement of Science at Bristol, 1–5 09 1986.Google Scholar
Macfarlane, A. and Mugford, M. (1984), Birth Counts: Statistics of Pregnancy and Childbirth, HMSO, London.Google Scholar
Macintyre, S. (1986), ‘Health and illness’, in Burgess, R. (ed.), Key Variables in Social Investigation, Routledge and Kegan Paul, London.Google Scholar
Macintyre, S. (1986a), ‘The patternings of health by social position in contemporary Britain: directions for sociological research’, Social Science and Medicine, 23, 4, 393–415.Google Scholar
McKeown, T.J. (1976), The Role of Medicine: Dream, Mirage or Nemesis, Nuffield Provincial Hospitals Trust, London.Google Scholar
McPherson, K. (1985), ‘Discussion to public controversies and scientific evidence’, reported in Royal Statistical Society News and Notes, 12, 6, 02 1986.Google Scholar
Marmot, M.G. (1986), ‘Social inequalities in mortality: the social environment’, in Wilkinson, R.G. (ed.), Class and Health: Research and Longitudinal Data, Tavistock, London.Google Scholar
Marmot, M.G. and McDowall, M.E. (1986), ‘Mortality decline and widening social inequalities’, The Lancet, 2 08, 274–277.CrossRefGoogle ScholarPubMed
Maxwell, R.J. (1981), Health and Wealth: An International Study of Health-Care Spending, Lexington Books, Massachusetts.Google Scholar
Mays, N. (1987), RAWP—Modifying the Formula, Occasional Papers No. 10, Department of Community Medicine, St. Thomas' Hospital, London.Google Scholar
Merrison, A. (1979), Report of the Royal Commission on the National Health Service, Cmnd 7615, HMSO, London.Google Scholar
Moser, K.A., Fox, A.J. and Jones, D.R. (1986), ‘Unemployment and mortality in the OPCS Longitudinal Study’, in Wilkinson, R.G. (ed.). Class and Health: Research and Longitudinal Data, Tavistock, London.Google Scholar
Office of Population Censuses and Surveys (OPCS) (1978), Occupational Mortality 1970–72, HMSO, London.Google Scholar
OPCS (1985), General Household Survey, Cigarette Smoking 1972 to 1984, (OPCS Monitor, GHS 85/2), HMSO, London.Google Scholar
OPCS (1986), Mortality Statistics, Perinatal and Infant: Social and Biological Factors for 1984, Series DH3, No. 17, HMSO, London.Google Scholar
OPCS (1986), Occupational Mortality Decennial Supplement, England and Wales 1979–80, 1982–83, HMSO. London.Google Scholar
Pamuk, E.R. (1985), ‘Social Class inequality in mortality from 1921 to 1972 in England and Wales’, Population Studies, 39. 17–31.Google Scholar
Power, C., Fogelman, K. and Fox, A.J. (1986), ‘Health and social mobility during the early years of life’, Working Paper No. 8, Natural Child Development Study User Support Group, City University, London.Google Scholar
Preston, S.H., Haines, M.R. and Pamuk, E.R. (1981), ‘Effects of industrialisation and urbanization on mortality in developed countries’, in Solicited Papers, Vol. 2, Nineteenth International Population Conference, Manila, 1981. IUSSP, Liège.Google Scholar
Prior, L. (1985), ‘Making sense of mortality’, Sociology of Health and Illness, 7, 2, 220–235.Google Scholar
Rose, G.A. and Marmot, M.G. (1981), ‘Social class and coronary heart disease’, British Heart Journal, 45, 13.CrossRefGoogle ScholarPubMed
Scott-Samuel, A. (1981), ‘Social class inequality in access to primary care: a critique of recent research’ British Medical Journal, 283, 570–571.Google Scholar
Scott-Samuel, A. (1986), ‘Social inequalities in health: back on the agenda’, The Lancet, 10.5.86, p. 108.Google Scholar
Scott-Samuel, A. (1986), Letter to New Society. 3.10.86.Google Scholar
Skrimshire, A. (1978). Area Disadvantage, Social Class and the Health Service, Department of Social and Administration Studies, University of Oxford, Oxford.Google Scholar
Smedby, B. and Ericson, A. (1979), ‘Perinatal mortality among children of immigrant mothers in Sweden’ in S. Sjohn (ed.), Perceptions of Child Health in Sweden, Supplement No. 275 to Acta Paediatrica Scandinavia.Google Scholar
Stern, J. (1983), ‘Social mobility and the interpretation of social class mortality differentials’, Journal of Social Policy, 12:1 27–49.Google Scholar
Thunhurst, C. (1985), ‘Close encounters of an economic kind’, Radical Community Medicine, 24, pp. 17–24.Google Scholar
Townsend, P. and Davidson, N. (1982), Inequalities in Health: The Black Report, Penguin, London.Google Scholar
Townsend, P., Phillimore, P. and Beattie, A. (1987), Health and Deprivation: Inequality and the North. Croom Helm, London.Google Scholar
Trades Union Council (1981), The Unequal Health of a Nation: A TUC Summary of the Black Report, TUC, London.Google Scholar
Wadsworth, M.E.J. (1986), ‘Serious illness in childhood and its association with later-life achievement’, in Wilkinson, R.G. (ed.), Class and Health: Research and Longitudinal Data, Tavistock, London.Google Scholar
Warr, P. (1985), ‘Twelve questions about unemployment and health’, in Roberts, B., Finnegan, R. and Gallie, D. (eds), New Approaches to Economic Life, Manchester University Press, Manchester.Google Scholar
Whitehead, M. (1987), The Health Divide: Inequalities in Health in the 1980s, Health Education Council, London.Google Scholar
Wilkinson, R.G. (ed.) (1986). Class and Health: Research and Longitudinal Data, Tavistock, London.Google Scholar
Wilkinson, R.G. (1986a), ‘Occupational class, selection and inequalities in health: a reply to Raymond Illsley’, Quarterly Journal of Social Affairs, 2 (4), 415–422.Google Scholar
Williams, A. (1985), ‘Economics of coronary artery by-pass grafting’, British Medical Journal, 291, 326–9.Google Scholar