Health inequalities

2019 ◽  
Author(s):  
Johan P. Mackenbach
Keyword(s):  
Social Inequality ◽  
Health Inequalities ◽  
Social Stratification ◽  
Premature Mortality ◽  
Welfare States ◽  
Comprehensive Overview ◽  
Systematic Analysis ◽  
State Reform ◽  
Lower Socioeconomic ◽  
National Governments

‘Health inequalities—persistence and change in European welfare states’ studies why frequencies of disease, disability, and premature mortality are higher among people with a lower socioeconomic position, even in countries with advanced welfare states. Drawing upon data from 30 countries covering more than three decades, it provides a comprehensive overview of trends and patterns of health inequalities, showing that these are not only ubiquitous and persistent, but also highly variable and dynamic. It provides a critical assessment of recent research into the explanation of health inequalities, discussing methodological pitfalls, summarizing findings from epidemiological, sociological, economic, and genetic studies, and reviewing nine overarching theories. Based on in-depth studies of the determinants of health inequalities in European countries, it shows that the persistence of health inequalities is due to a combination of mostly favourable changes in social stratification, massive but differential health improvements, and persistence of social inequality in material and non-material living conditions. It discusses why social inequality is so persistent, and whether welfare state reform could contribute to reducing health inequalities, and provides a systematic analysis of the inequitableness of health inequalities according to five theories of justice. It reviews recent attempts by European national governments to reduce health inequalities, showing that it is realistic to expect evidence-based policies to reduce absolute but not relative inequalities in health. This title is written for scientists and advanced students from various disciplines, as well as for public health professionals and policymakers, and is profusely illustrated and referenced.

A broader picture

2019 ◽  
pp. 141-162
Author(s):  
Johan P. Mackenbach
Keyword(s):  
Social Inequality ◽  
Health Inequalities ◽  
Capabilities Approach ◽  
State Reform ◽  
Justice As Fairness ◽  
Active Labour ◽  
Theories Of Justice ◽  
Recent Trends ◽  
The Common ◽  
Reducing Costs

Chapter 5 (‘A broader picture’) first discusses why not only health inequalities, but also social inequality is so persistent. After reviewing sociological theories from both the ‘functionalist’ and ‘conflict’ traditions, it chooses a middle road which acknowledges the ineradicable nature of social inequality. It then describes recent trends in welfare state reform, and identifies several areas, such as pensions and active labour market policies, where more attention to health inequalities is required. It also evaluates the common intuition that health inequalities are ‘unjust’, by applying five theories of justice (‘equality of welfare’, ‘capabilities approach’, ‘luck egalitarianism’, ‘justice as fairness’, and ‘equality of opportunity’). It concludes that, although health inequalities are not simply a form of social injustice, there are several compelling reasons to reduce health inequalities, including avoiding accumulation of disadvantage, solidarity with the less well-off, and reducing costs to society.

Introduction

2019 ◽  
pp. 1-12
Author(s):  
Johan P. Mackenbach
Keyword(s):  
Welfare State ◽  
Social Inequality ◽  
Health Inequalities ◽  
Population Level ◽  
Welfare States ◽  
Short History ◽  
History Of ◽  
Micro Level ◽  
Per Se

Chapter 1 (‘Introduction’) provides a short history of the discovery and rediscovery of health inequalities, as well as a short history and typology of the welfare state, and lays out the paradox that this book tries to explain: the persistence of health inequalities in even the most universal and generous European welfare states. It argues that micro-level studies alone cannot resolve this paradox, and that macro-level studies are needed to identify the determinants of health inequalities as seen at the population level. This will also make it easier to put health inequalities into a broader perspective, for example, that of social inequality per se. This chapter ends with an extensive preview of the main conclusions of the book.

Persistence of social inequalities in modern welfare states: Explanation of a paradox

2016 ◽  
Vol 45 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Johan P Mackenbach
Keyword(s):  
Social Inequality ◽  
Health Inequalities ◽  
Social Inequalities ◽  
Welfare States ◽  
Short Supply ◽  
Individual Level ◽  
Self Interest ◽  
Sociological Literature ◽  
Underlying Mechanisms ◽  
Specific Manifestation

Aims: Social–epidemiological explanations of health inequalities usually take the existence of social inequality as a given and ignore the fundamental questions of why social inequality exists in the first place and why it is so persistent. I review here theories of the explanation of social inequality to identify the processes and/or structures responsible for its persistence. Methods: This paper is a review of the relevant sociological literature. Results: The sociological literature suggests that what persists over long periods of time is not a specific manifestation of social inequality but a ‘meta-phenomenon’: the fact that there are different social positions, that these social positions give access to different levels of resources in some graded way and that the distribution of individuals over social positions follows rules that create inequalities in the opportunities for achieving a more advantaged social position. The durability of social inequality in this generic form can then be understood from the persistence of the underlying mechanisms and processes – for example, humans are driven by self-interest, while most objects of their striving are in short supply, therefore a struggle for rewards is present in all societies; humans are unequally endowed, therefore some are more successful in this struggle for resources than others; and the inequalities resulting from these individual level actions are structurally fixated through the intergenerational transmission of (dis)advantage, various societal institutions, and cultural factors. Conclusions: The sociological literature suggests that some mechanisms producing and perpetuating social inequality are more ‘benign’ than others. Health inequalities may be more than a consequence of social inequality and may play a more profound part by amplifying social inequalities.

New forms of intra-European migration, labour market dynamics and social inequality in Europe

2014 ◽  
Vol 11 (2) ◽  
pp. 125-136 ◽  
Author(s):  
Roland Verwiebe ◽  
Laura Wiesböck ◽  
Roland Teitzer
Keyword(s):  
Labour Market ◽  
Social Inequality ◽  
Social Stratification ◽  
Labour Markets ◽  
Second Step ◽  
Market Dynamics ◽  
Migration Patterns ◽  
European Continent ◽  
The Past ◽  
European Migration

This article deals mainly with new forms of Intra-European migration, processes of integration and inequality, and the dynamics of emerging transnational labour markets in Europe. We discuss these issues against the background of fundamental changes which have been taking place on the European continent over the past two decades. Drawing on available comparative European data, we examine, in a first step, whether the changes in intra-European migration patterns have been accompanied by a differentiation of the causes of migration. In a second step, we discuss the extent to which new forms of transnational labour markets have been emerging within Europe and their effects on systems of social stratification.

scholarly journals Levelling up: Global examples of reducing health inequalities

2021 ◽  
pp. 140349482110224
Author(s):  
Clare Bambra
Keyword(s):  
Civil Rights ◽  
Health Inequalities ◽  
Health Care Access ◽  
Economic Status ◽  
Population Level ◽  
Welfare States ◽  
State Expansion ◽  
Care Access ◽  
The Social ◽  
The 1950S

There are significant inequalities in health by socio-economic status, race/ethnicity, gender, neighbourhood deprivation and other axes of social inequality. Reducing these health inequalities and improving health equity is arguably the ‘holy grail’ of public health. This article engages with this quest by presenting and analysing historical examples of when sizeable population-level reductions in health inequalities have been achieved. Five global examples are presented ranging from the 1950s to the 2000s: the Nordic social democratic welfare states from the 1950s to the 1970s; the Civil Rights Acts and War on Poverty in 1960s USA; democratisation in Brazil in the 1980s; German reunification in the 1990s; and the English health inequalities strategy in the 2000s. Welfare state expansion, improved health care access, and enhanced political incorporation are identified as three commonly held ‘levellers’ whereby health inequalities can be reduced – at scale. The article concludes by arguing that ‘levelling up’ population health through reducing health inequalities requires the long-term enactment of macro-level policies that aggressively target the social determinants of health.

Communication Issues in Pervasive Healthcare Systems and Applications

2010 ◽  
pp. 197-227 ◽  
Author(s):  
Demosthenes Vouyioukas ◽  
Ilias Maglogiannis
Keyword(s):  
Healthcare Delivery ◽  
Communication Technologies ◽  
Mobile Technologies ◽  
Future Trends ◽  
Healthcare Applications ◽  
Comprehensive Overview ◽  
Systematic Analysis ◽  
Pervasive Healthcare ◽  
Body Sensors

This book chapter provides a systematic analysis of the communication technologies used in healthcare and homecare, their applications and the utilization of the mobile technologies in the healthcare sector by using in addition case studies to highlight the successes and concerns of homecare projects. There are several software applications, appliances, and communication technologies emerging in the homecare arena, which can be combined in order to create a pervasive mobile health system. This study highlights the key areas of concern and describes various types of applications in terms of communications’ performance. A comprehensive overview of some of these homecare, healthcare applications and research are presented. The technologies regarding the provision of these systems are described and categorised in two main groups: synchronous and asynchronous communications’ systems and technologies. The recent advances in homecare using wireless body sensors and on/off-body networks technologies are discussed along with the provision of future trends for pervasive healthcare delivery. Finally, this book chapter ends with a brief discussion and concluding remarks in succession to the future trends.

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