Health selection: the role of inter- and intra-generational mobility on social inequalities in health

2003 ◽  
Vol 57 (11) ◽  
pp. 2217-2227 ◽  
Author(s):  
Orly Manor ◽  
Sharon Matthews ◽  
Chris Power
Author(s):  
Lynette Reid

Abstract Within-country social inequalities in health have widened while global health inequalities have (with some exceptions) narrowed since the Second World War. On commonly accepted prioritarian and sufficientist views of justice and health, these two trends together would be acceptable: the wealthiest of the wealthy are pulling ahead, but the worst off are catching up and more are achieving sufficiency. Such commitments to priority or sufficiency are compatible with a common “development” narrative about economic and social changes that accompany changes (“transitions”) in population health. I set out a very simple version of health egalitarianism (without commitment to any particular current theory of justice) and focus on two common objections to egalitarianism. Priority and sufficiency both address the levelling down and formalism objections, but these objections are distinct: giving content to equality (I argue here) places in question the claimed normative superiority of priority and sufficiency. Using examples of the role of antimicrobials in both these trends – and the future role of AMR – I clarify (first) the multiple forms and dimensions of justice at play in health, and (second) the different mechanisms at work in generating the two current patterns (seen in life course narratives and narratives of political economy). The “accelerated transition” that narrowed global health inequalities is fed by anti-microbials (among other technology transfers). It did not accelerate but replaced the causal processes by which current HICs achieved the transition (growing and shared economic prosperity and widening political franchise). The impact of AMR on widening social inequalities in health in HICs will be complex: inequality has been fed in part by tertiary care enabled by antimicrobials; AMR might erode the solidarity underlying universal health systems as the well-off seek to maintain current expectations of curative and rehabilitative surgery and chemotherapy while AMR mounts. In light of both speculations about the impact of AMR on social and global health inequalities, I close with practical and with theoretical reflection. I briefly indicate the practical importance of understanding AMR from the perspective of health justice for policy response. Then, from a broader perspective, I argue that the content by which I meet the formalism objection demonstrates that the two trends (broadening within-country inequality and narrowing global inequality) are selective and biased samples of a centuries-long pattern of widening social inequalities in health. We are not in the midst of a process of “catching up”. In light of the long-term pattern described here, is the pursuit of sufficiency or priority morally superior to the pursuit of equality as a response to concrete suffering – or do they rationalize a process more objectively described as the best-off continuing to take the largest share of one of the most important benefits of economic development?


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract Context Socioeconomic inequalities in health and ageing are observed across contexts and over time, presenting a challenge for public health. The mechanisms driving associations between social conditions and health include biological responses, which in turn are associated with health outcomes. This workshop aims to describe and discuss evidence on the biological embedding of the social environment from research carried out within a large European consortium, and place it within the context of public health. Methods The Lifepath project was funded by the European Commission between 2014-19 and brought together longitudinal datasets from across Europe, as well as an interdisciplinary collective of researchers keen to examine how social inequalities in health are constructed over the lifecourse. Results Four separate studies are presented here. First, Carmeli et al examine the relationship between social position and systemic inflammation through the mediating role of gene regulation. Second, Fraga et al describe the social patterning of chronic inflammation observed in early adolescence. Third, Castagné et al analyse the relationship between social position across the lifecourse and systemic inflammation, and the role of inflammation within the allostatic load heuristic. Fourth, Chadeau-Hyam et al describe social gradients in a multi-system biological health score, and its subsequent relationship with a number of major health outcomes. Discussion We will coordinate a discussion between the audience and workshop participants. The contribution of the inflammatory system to capturing social inequalities and in its association with chronic disease will be discussed. Is it a key player in the construction of health inequalities, or merely an effective signal for many diverse processes? The role biological markers can play in enhancing our understanding of health inequalities, and how the public health community can respond to the evidence will be discussed. Conclusions Socially patterned biological responses begin early in the lifecourse and may be key factors in the construction of social inequalities in health and ageing. As such, they should be taken into account in public health activities and policy. Key messages The biological embodiment of social conditions is observed from early life and across the lifecourse. Systemic inflammation appears to be a central mechanism which is socially patterned and associated with many health outcomes.


Author(s):  
Jochen Drewes ◽  
Jennifer Ebert ◽  
Phil C. Langer ◽  
Dieter Kleiber ◽  
Burkhard Gusy

A correction to this paper has been published: https://doi.org/10.1007/s11136-021-02854-w


Sign in / Sign up

Export Citation Format

Share Document