health inequality sociology essay

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13.1 Sociological Perspectives on Health and Health Care

Learning objective.

• List the assumptions of the functionalist, conflict, and symbolic interactionist perspectives on health and medicine.

Before discussing these perspectives, we must first define three key concepts—health, medicine, and health care—that lie at the heart of their explanations and of this chapter’s discussion. Health refers to the extent of a person’s physical, mental, and social well-being. As this definition suggests, health is a multidimensional concept. Although the three dimensions of health just listed often affect each other, it is possible for someone to be in good physical health and poor mental health, or vice versa. Medicine refers to the social institution that seeks to prevent, diagnose, and treat illness and to promote health in its various dimensions. This social institution in the United States is vast, to put it mildly, and involves more than 11 million people (physicians, nurses, dentists, therapists, medical records technicians, and many other occupations). Finally, health care refers to the provision of medical services to prevent, diagnose, and treat health problems.

With these definitions in mind, we now turn to sociological explanations of health and health care. As usual, the major sociological perspectives that we have discussed throughout this book offer different types of explanations, but together they provide us with a more comprehensive understanding than any one approach can do by itself. Table 13.1 “Theory Snapshot” summarizes what they say.

Table 13.1 Theory Snapshot

The Functionalist Approach

As conceived by Talcott Parsons (1951), the functionalist perspective emphasizes that good health and effective medical care are essential for a society’s ability to function. Ill health impairs our ability to perform our roles in society, and if too many people are unhealthy, society’s functioning and stability suffer. This was especially true for premature death, said Parsons, because it prevents individuals from fully carrying out all their social roles and thus represents a “poor return” to society for the various costs of pregnancy, birth, child care, and socialization of the individual who ends up dying early. Poor medical care is likewise dysfunctional for society, as people who are ill face greater difficulty in becoming healthy and people who are healthy are more likely to become ill.

For a person to be considered legitimately sick, said Parsons, several expectations must be met. He referred to these expectations as the sick role . First, sick people should not be perceived as having caused their own health problem. If we eat high-fat food, become obese, and have a heart attack, we evoke less sympathy than if we had practiced good nutrition and maintained a proper weight. If someone is driving drunk and smashes into a tree, there is much less sympathy than if the driver had been sober and skidded off the road in icy weather.

Second, sick people must want to get well. If they do not want to get well or, worse yet, are perceived as faking their illness or malingering after becoming healthier, they are no longer considered legitimately ill by the people who know them or, more generally, by society itself.

Third, sick people are expected to have their illness confirmed by a physician or other health-care professional and to follow the professional’s instructions in order to become well. If a sick person fails to do so, she or he again loses the right to perform the sick role.

Talcott Parsons wrote that for a person to be perceived as legitimately ill, several expectations, called the sick role, must be met. These expectations include the perception that the person did not cause her or his own health problem.

Nathalie Babineau-Griffith – grand-maman’s blanket – CC BY-NC-ND 2.0.

If all these expectations are met, said Parsons, sick people are treated as sick by their family, their friends, and other people they know, and they become exempt from their normal obligations to all these people. Sometimes they are even told to stay in bed when they want to remain active.

Physicians also have a role to perform, said Parsons. First and foremost, they have to diagnose the person’s illness, decide how to treat it, and help the person become well. To do so, they need the cooperation of the patient, who must answer the physician’s questions accurately and follow the physician’s instructions. Parsons thus viewed the physician-patient relationship as hierarchical: the physician gives the orders (or, more accurately, provides advice and instructions), and the patient follows them.

Parsons was certainly right in emphasizing the importance of individuals’ good health for society’s health, but his perspective has been criticized for several reasons. First, his idea of the sick role applies more to acute (short-term) illness than to chronic (long-term) illness. Although much of his discussion implies a person temporarily enters a sick role and leaves it soon after following adequate medical care, people with chronic illnesses can be locked into a sick role for a very long time or even permanently. Second, Parsons’s discussion ignores the fact, mentioned earlier, that our social backgrounds affect the likelihood of becoming ill and the quality of medical care we receive. Third, Parsons wrote approvingly of the hierarchy implicit in the physician-patient relationship. Many experts say today that patients need to reduce this hierarchy by asking more questions of their physicians and by taking a more active role in maintaining their health. To the extent that physicians do not always provide the best medical care, the hierarchy that Parsons favored is at least partly to blame.

The Conflict Approach

The conflict approach emphasizes inequality in the quality of health and of health-care delivery (Weitz, 2013). As noted earlier, the quality of health and health care differs greatly around the world and within the United States. Society’s inequities along social class, race and ethnicity, and gender lines are reproduced in our health and health care. People from disadvantaged social backgrounds are more likely to become ill, and once they do become ill, inadequate health care makes it more difficult for them to become well. As we will see, the evidence of disparities in health and health care is vast and dramatic.

The conflict approach also critiques efforts by physicians over the decades to control the practice of medicine and to define various social problems as medical ones. Physicians’ motivation for doing so has been both good and bad. On the good side, they have believed they are the most qualified professionals to diagnose problems and to treat people who have these problems. On the negative side, they have also recognized that their financial status will improve if they succeed in characterizing social problems as medical problems and in monopolizing the treatment of these problems. Once these problems become “medicalized,” their possible social roots and thus potential solutions are neglected.

Several examples illustrate conflict theory’s criticism. Alternative medicine is becoming increasingly popular, but so has criticism of it by the medical establishment. Physicians may honestly feel that medical alternatives are inadequate, ineffective, or even dangerous, but they also recognize that the use of these alternatives is financially harmful to their own practices. Eating disorders also illustrate conflict theory’s criticism. Many of the women and girls who have eating disorders receive help from a physician, a psychiatrist, a psychologist, or another health-care professional. Although this care is often very helpful, the definition of eating disorders as a medical problem nonetheless provides a good source of income for the professionals who treat it and obscures its cultural roots in society’s standard of beauty for women (Whitehead & Kurz, 2008).

Obstetrical care provides another example. In most of human history, midwives or their equivalent were the people who helped pregnant women deliver their babies. In the nineteenth century, physicians claimed they were better trained than midwives and won legislation giving them authority to deliver babies. They may have honestly felt that midwives were inadequately trained, but they also fully recognized that obstetrical care would be quite lucrative (Ehrenreich & English, 2005).

According to conflict theory, physicians have often sought to define various social problems as medical problems. An example is the development of the diagnosis of ADHD, or attention deficit/hyperactivity disorder.

birgerking – What I Really Do… ADD/ADHD – CC BY 2.0.

In a final example, many hyperactive children are now diagnosed with ADHD, or attention deficit/hyperactivity disorder. A generation or more ago, they would have been considered merely as overly active. After Ritalin, a drug that reduces hyperactivity, was developed, their behavior came to be considered a medical problem and the ADHD diagnosis was increasingly applied, and tens of thousands of children went to physicians’ offices and were given Ritalin or similar drugs. The definition of their behavior as a medical problem was very lucrative for physicians and for the company that developed Ritalin, and it also obscured the possible roots of their behavior in inadequate parenting, stultifying schools, or even gender socialization, as most hyperactive kids are boys (Conrad, 2008; Rao & Seaton, 2010).

Critics say the conflict approach’s assessment of health and medicine is overly harsh and its criticism of physicians’ motivation far too cynical. Scientific medicine has greatly improved the health of people around the world. Although physicians are certainly motivated, as many people are, by economic considerations, their efforts to extend their scope into previously nonmedical areas also stem from honest beliefs that people’s health and lives will improve if these efforts succeed. Certainly there is some truth in this criticism of the conflict approach, but the evidence of inequality in health and medicine and of the negative aspects of the medical establishment’s motivation for extending its reach remains compelling.

The Symbolic Interactionist Approach

The symbolic interactionist approach emphasizes that health and illness are social constructions . This means that various physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society and its members (Buckser, 2009; Lorber & Moore, 2002). The ADHD example just discussed also illustrates symbolic interactionist theory’s concerns, as a behavior that was not previously considered an illness came to be defined as one after the development of Ritalin. In another example first discussed in Chapter 7 “Alcohol and Other Drugs” , in the late 1800s opium use was quite common in the United States, as opium derivatives were included in all sorts of over-the-counter products. Opium use was considered neither a major health nor legal problem. That changed by the end of the century, as prejudice against Chinese Americans led to the banning of the opium dens (similar to today’s bars) they frequented, and calls for the banning of opium led to federal legislation early in the twentieth century that banned most opium products except by prescription (Musto, 2002).

In a more current example, an attempt to redefine obesity is now under way in the United States. Obesity is a known health risk, but a “fat pride” or “fat acceptance” movement composed mainly of heavy individuals is arguing that obesity’s health risks are exaggerated and calling attention to society’s discrimination against overweight people. Although such discrimination is certainly unfortunate, critics say the movement is going too far in trying to minimize obesity’s risks (Diamond, 2011).

The symbolic interactionist approach has also provided important studies of the interaction between patients and health-care professionals. Consciously or not, physicians “manage the situation” to display their authority and medical knowledge. Patients usually have to wait a long time for the physician to show up, and the physician is often in a white lab coat; the physician is also often addressed as “Doctor,” while patients are often called by their first name. Physicians typically use complex medical terms to describe a patient’s illness instead of the more simple terms used by laypeople and the patients themselves.

Management of the situation is perhaps especially important during a gynecological exam, as first discussed in Chapter 12 “Work and the Economy” . When the physician is a man, this situation is fraught with potential embarrassment and uneasiness because a man is examining and touching a woman’s genital area. Under these circumstances, the physician must act in a purely professional manner. He must indicate no personal interest in the woman’s body and must instead treat the exam no differently from any other type of exam. To further “desex” the situation and reduce any potential uneasiness, a female nurse is often present during the exam.

Critics fault the symbolic interactionist approach for implying that no illnesses have objective reality. Many serious health conditions do exist and put people at risk for their health regardless of what they or their society thinks. Critics also say the approach neglects the effects of social inequality for health and illness. Despite these possible faults, the symbolic interactionist approach reminds us that health and illness do have a subjective as well as an objective reality.

Key Takeaways

• A sociological understanding emphasizes the influence of people’s social backgrounds on the quality of their health and health care. A society’s culture and social structure also affect health and health care.
• The functionalist approach emphasizes that good health and effective health care are essential for a society’s ability to function, and it views the physician-patient relationship as hierarchical.
• The conflict approach emphasizes inequality in the quality of health and in the quality of health care.
• The interactionist approach emphasizes that health and illness are social constructions; physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society and its members.

For Your Review

• Which approach—functionalist, conflict, or symbolic interactionist—do you most favor regarding how you understand health and health care? Explain your answer.
• Think of the last time you visited a physician or another health-care professional. In what ways did this person come across as an authority figure possessing medical knowledge? In formulating your answer, think about the person’s clothing, body position and body language, and other aspects of nonverbal communication.

Buckser, A. (2009). Institutions, agency, and illness in the making of Tourette syndrome. Human Organization, 68 (3), 293–306.

Conrad, P. (2008). The medicalization of society: On the transformation of human conditions into treatable disorders . Baltimore, MD: Johns Hopkins University Press.

Diamond, A. (2011). Acceptance of fat as the norm is a cause for concern. Nursing Standard, 25 (38), 28–28.

Lorber, J., & Moore, L. J. (2002). Gender and the social construction of illness (2nd ed.). Lanham, MD: Rowman & Littlefield.

Musto, D. F. (Ed.). (2002). Drugs in America: A documentary history . New York, NY: New York University Press.

Parsons, T. (1951). The social system . New York, NY: Free Press.

Rao, A., & Seaton, M. (2010). The way of boys: Promoting the social and emotional development of young boys . New York, NY: Harper Paperbacks.

Weitz, R. (2013). The sociology of health, illness, and health care: A critical approach (6th ed.). Thousand Oaks, CA: Wadsworth.

Whitehead, K., & Kurz, T. (2008). Saints, sinners and standards of femininity: Discursive constructions of anorexia nervosa and obesity in women’s magazines. Journal of Gender Studies, 17 , 345–358.

Social Problems Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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The concepts of health inequality, disparities and equity in the era of population health

a Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, MA, USA

b College of Nursing, Daeyang University, Lilongwe, Malawi

Deogwoon Kim

Jacqueline fawcett, 1. introduction.

Unequal distribution of health and health care among groups of the U.S. population has been a national health problem at least since the founding of the country. The problem of differences in health status within the United States (U.S.). Population by factors such as race/ethnicity, gender, education, and geography ( National Academies of Sciences, Engineering, and Medicine, 2017 ) direct our attention and perspectives away from individual risk factors and toward factors that influence population health.

The term, “population health” has evolved over last three decades in response to the questions, “What makes some people healthy and others unhealthy?” ( Kindig, 2007 ; Robert Wood Johnson, 2017 ; Young, 2004 ) and “Why treat people's illness without changing what makes them sick in the first place?” ( WHO, 2008 ) These questions imply that there is an unequal distribution of health outcomes across populations as well as an unequal distribution of societal factors influencing health. Consequently, the concepts of disparity, inequity, inequality and their antecedents require our attention and should be incorporated as a guide for health policies and interventions targeted to populations. The purpose of this paper is to define health inequality, health disparity, and health inequity from a population health perspective and to illustrate the meaning of each term by presenting authentic real-world examples. This paper will extend our understanding of these concepts from an individual perspective to a population perspective ( Fawcett, 2019 ).

2. Definitions of health inequality, health disparities, and health inequity in population health

2.1. health inequality.

Dictionaries define inequality as the “quality of being unequal or uneven” ( Merriam-Webster, n.d. ). The term, health inequality, used in most countries other than the U.S., is based on the seminal work of Margaret Whitehead in the United Kingdom ( Whitehead, 2007 ), and refers not only to the quality of being unequal or uneven in health outcomes between groups but also to differences in social hierarchy. For the purposes of this paper, health inequality is defined as differences in the distribution of health status and achievement of health outcomes that exist among specific groups due to genetic or other factors that cannot be prevented or modified ( Kawachi et al., 2002 ).

Example 1 illustrates an unequal distribution of health conditions. These conditions are the result of gender associated biological differences rather than to avoidable social conditions ( Keyes & Galea, 2016 ). Women have a much higher incidence and morality of breast cancer than do men. Prostate cancer may be a better example of inequality of health conditions as only men can have prostate cancer, inasmuch as women obviously do not have a prostate gland.

An example of health inequalities: Differences in types of cancers by gender.

Gender inequalities by type of cancer: incidence and mortality of cancers worldwide ( GLOBOCAN, 2018 online analysis, http://globocan.iarc.fr ).

There is a higher incidence and mortality related to breast cancer among women than men.

2.2. Health disparities

Braveman et al. (2011) defined health disparities as systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups. In this definition, health disparities refer to both the different distribution of health outcomes as well as the different distribution of social determinants that are antecedents responsible for either promoting or decreasing the health of a population. Similarly, the U.S. Centers for Disease Control and Prevention ( CDC, 2018 ) defined health disparity as the preventable differences in the burden of disease, injury, violence, or the opportunities to achieve optimal health that are experienced by socially disadvantaged populations. These definitions refer to poor health outcomes among socially disadvantaged people without further specification. Healthy People 2010 had defined health disparities in very general terms as the differences in health among different population groups. It is interesting to note that one of the two overarching goals of Health People 2010 was “eliminating health disparities” which was a more aggressive change from “reducing health disparities” of Healthy People 2000. Recognizing the need for clarity, Healthy People 2020 defined health disparities as a particular type of health difference that is closely linked with economic, social, or environmental disadvantage ( National Academics of Sciences, Engineering, and Medicine, 2019 ). Thus, health disparity refers to the systematic difference in any measurable aspect of health outcomes across populations due to the different distribution of social conditions across these populations.

Example 2 illustrates the meaning of health disparities.

COVID-19 incident rates.

COVID-19 incidence rates by race.

The graph based on the CDC weekly COVID-19 data by race, from January 22, 2020 to May 30, 2020 depicts disproportionally high infection rates among minority ethnicity. Among the 1,761,503 aggregate cases reported to CDC, individual case reports for 1,406,098 were submitted to CDC case surveillance. Among 599,636 cases with known race and ethnicity, 34% were Hispanic or Latino of any race (Hispanic), 21% were non-Hispanic black (black). These findings pointed out to the fact that these groups account for 18% and 13% of the U.S. population, respectively, are disproportionally affected by the COVID-19 pandemic.

Example 2 focuses on COVID-19 infection incidence rates to illustrate differences in health outcomes due to the different distribution of social conditions of race, living conditions, occupations, and health care access which cause the deteriorating health outcomes of COVID-19 mortality ( Stokes et al., 2020 ). Disaggregating data by race reveals that there are higher rates of COVID-19 infection among Blacks and Hispanics in all age groups. Thirty-three percent of those infected were Hispanic, and 22% were Black, whereas these groups account for only 18% and 13% of the U.S. population ( U.S. Census Bureau, 2020 ), respectively. Physical risk factors such as CVD, diabetes, and chronic lung disease cannot fully explain why Blacks and Hispanics, especially, Hispanics are disproportionately infected with COVID-19 ( Stokes et al., 2020 ). Social determinants can help to explain this health disparity. The members of these ethnic minority groups are more likely to work in service industries that require interaction with the general public or close contract with co-workers, are not amendable to teleworking, and use public transportation ( U.S. Bureau of Labor Statistic, 2019 ; Substance Abuse and Mental Health Services Administration [SAMHSA], 2020 ) that place them at risk for exposure to COVID-19. They are more likely to be uninsured or/and do not have a usual source of health care, which are barriers to accessing COVID-19 testing and treatment ( Hayes et al., 2017 ; SAMHSA, 2020 ). Moreover, they are more likely to live in public, multigenerational, or multi-family housing where social distancing and self-isolation are impossible ( Cohn & Passel, 2018 ; SAMHSA, 2020 ). Thus, the definition and measurement of disparities in COVID-19 infection requires greater emphasis on understanding the places where they live and where they work.

2.3. Health inequity

Healthy People 2020 defines equity to mean social justice or fairness; it is an ethical concept, grounded in principles of distributive justice. The Secretary's Advisory Committee for Healthy People 2030 (2018) recommended that achieving health equity require eliminating avoidable, unjust, and unfair health inequities and health disparities through short- and long-term actions. However, Lowe (2015) has pointed out that equity in health is considered a value judgment on the equal or unequal health status of individuals, families, communities, or whole populations.

The term of inequity has evolved over time starting from differences between groups of people, with a focus on the quality of being fair, impartial, and inequality ( Oxford English Dictionary, n.d. ) to the World Health Organization ( WHO, 2020 ) definition of “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically”. We posit that health inequity is the difference in health outcomes of populations due to avoidable antecedent factors, which is an unfair and social injustice.

Example 3 illustrates the health inequity of funding for sickle cell anemia (SCD) research. Approximately 70,000 to 100,000 Americans have sickle cell disease, the most common form of an inherited blood disorder. It is more common among people of African descent, about 1 in 13 carriers of the sickle cell gene are African American ( CDC, 2019 ). The difference in sickle cell anemia incidence across populations can be considered an inequality because sickle cell anemia is a genetic disease, which is caused by a mutation in the hemoglobin-Beta gene found on chromosome 11 ( Ashley-Koch et al., 2000 ; Steinberg & Sebastiani, 2012 ). This description sounds like health inequality because the difference is due to unavoidable biological factors. However, if this case is further unpacked we find that there are a number of avoidable factors including that life expectancy is 30 years shorter than people without sickle cell anemia, that the majority of the sickle cell anemia population are Medicaid beneficiaries, that these people experience longer waiting times to see a physician or get pain medication, and that the number of physicians trained and willing to treat sickle cell anemia patients is limited. Moreover, although this disease was discovered move than 100 years ago, there are only two medications that have been approved for treatment of the disease (see Example 3 ). This seems to indicate that this disease, which is most frequently found among Blacks, has received little attention including the research and funding necessary for better treatment. The differences in health outcomes in this case are a result of systemic and unjust distribution of treatment and research opportunities.

An example of health inequities in research funding: Sickle cell anemia disease and cystic fibrosis

NIH research funding and private, nonprofit association support of SCD and cystic fibrosis.

Sickle cell anemia disease (SCD) is the world's most common genetic disease, occurring in 1 of every 16,300 Hispanic-Americans and Whites, 1 of 365 Blacks (including 1 in 13 Black infants) ( CDC, 2019 ). However, National Institutes of Health research funding for cystic fibrosis, which occurs in only a third of the number affected by SCD, is 3.5 times than for SCD research, and private foundation funding is approximately 400 times higher for cystic fibrosis than for SCD.

3. Discussion

The terms inequality, disparity, and inequity are often used interchangeably in population health without clarification of their meanings, underlying values, and antecedents. For example, Healthy People's overarching goals increasingly recognize the differences in health outcomes of groups of the U.S. population and the importance of the societal impact on health. Healthy People 2000 was the first to introduce the term focused on reducing disparities, and it was strengthened in 2010 with a call to eliminate disparities. Health People 2020 included achieving equity and recognized the need for improving social and physical environments that promote health for all. However, it is important to define terms before developing metrics about them and deciding what we would like to accomplish. Therefore, we propose the definitions of equality, disparity, and equity in health we have given in this paper (see the Table 1 ). Clarifying these concepts and having accurate and meaningful metrics to measure the socioeconomic and demographic factors of health, as well as measures that address disparities in health and health care, can have a major impact on population health. It seems that the definitions of health equity are more than ones simply reflecting differences in health outcomes or that are empirically measurable. Measuring health inequities requires consideration of how to define unfair inequalities, inasmuch as social justice and fairness can be interpreted differently from different ethical, legal, and technical perspectives, these values may generate different definitions of health inequity. However, the distinctions are important because they inform health strategies and health policies that guide priorities and resource distribution to improve population health more broadly or to reduce health inequities with a focus on fairness and justice.

Definitions of concepts.

Noteworthy is that health inequity is linked with health disparity, inasmuch as health inequity is measured by health disparities metrics. In particular, whereas health disparity is the metric for assessing health equity, health inequity includes the additional dimension of the human right to have good health and social justice. Furthermore, inequities in health care are a result of unfair, avoidable differences in access to the resources needed to improve and maintain health or health outcomes and offer policy relevant information, whereas health inequality simply refers to the uneven distribution of health conditions or health outcomes.

4. Clinical implications

The WHO Constitution declared in 1948 that, “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” ( Meier, 2017 ). This statement constitutes a very powerful mandate of moving toward health equity as a human right. Health equity is a subset of health differences between countries and within countries. It is relevant to social justice because these differences are deeply rooted in social conditions related to systematic associations with avoidable health differences. Clear definitions will assist us to develop effective health policies and strategies and determine priorities for use of limited resources and to accurately measure the health of populations and determinants of health as well as assess progress in these areas. However, the notion of “avoidability” can be highly subjective. Clarifying the meaning of health inequality, disparity, and inequity, with an understanding of the philosophical value-laden subjectivity of health equity will enable nurse practitioners, educators, researchers, and health policy makers to be more effective in advocating for what conditions make health disparities unfair and unjust and in development strategies to move toward health equity. This, in turn, may lead to further clarification and consistency in our communication about population health and fairness in the distribution of health outcomes and health resources.

CRediT authorship contribution statement

Haeok Lee: Conceptualization, Methodology, Writing - original draft. Deogwoon Kim: Resources, Visualization, Validation. SangA Lee: Resources, Visualization, Validation. Jacqueline Fawcett: Validation, Writing - review & editing.

• Ashley-Koch A., Yang Q., Olney R.S. Sickle hemoglobin (Hb S) allele and sickle cell disease: A HuGE review. American Journal of Epidemiology. 2000; 151 (9):839–845. doi: 10.1093/oxfordjournals.aje.a010288. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Braveman P.A., Egerter S.A., Woolf S.H., Marks J.S. When do we know enough to recommend action on the social determinants of health? American Journal of Preventive Medicine. 2011; 40 (1 Suppl 1):S58–S66. doi: 10.1016/j.amepre.2010.09.026. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Centers for Disease Control and Prevention Adolescent and school health: Health disparities. 2018. https://www.cdc.gov/healthyyouth/disparities/index.htm
• Centers for Disease Control and Prevention Data & statistics on sickle cell disease. 2019. https://www.cdc.gov/ncbddd/sicklecell/data.html
• Cohn D., Passel J.S. A record 64 million Americans live in multigenerational households. 2018. https://www.pewresearch.org/fact-tank/2018/04/05/a-record-64-million-americans-live-in-multigenerational-households/
• Cystic Fibrosis Foundation Annual report 2018. https://www.cff.org/About-Us/Assets/2018-Annual-Report.pdf (n.d.)
• Fawcett J. Thoughts about the language of equity for population health. Nursing Science Quarterly. 2019; 32 (2):157–159. doi: 10.1177/0894318419826277. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• GLOBOCAN Estimated age-standardized incidence and mortality rates (world) in 2018. 2018. https://gco.iarc.fr/today/online-analysis-dual-bars-2?v=2018&mode=cancer&mode_population=regions&population=250&populations=250&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=1&include_nmsc_other=1&dual_distribution=2&population1=250&population2=554&show_values=false&type_multiple=%257B%2522inc%2522%253Atrue%252C%2522mort%2522%253Atrue%252C%2522prev%2522%253Afalse%257D&population_group_globocan_id=&type_sort=0
• Hayes S.L., Riley P., Radley D.C., McCarthy D. Reducing racial and ethnic disparities in access to care: Has the Affordable Care Act made a difference? 2017. https://www.commonwealthfund.org/publications/issue-briefs/2017/aug/reducing-racial-and-ethnic-disparities-access-care-has [ PubMed ]
• Kawachi I., Subramanian S., Almeida-Filho H. A glossary for health inequalities. Journal of Epidemiology and Community Health. 2002; 56 (9):647–652. doi: 10.1136/jech.56.9.647. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Keyes K., Galea S. Oxford University Press; 2016. Population health science. [ Google Scholar ]
• Kindig D.A. Understanding population health terminology. The Milbank Quarterly. 2007; 85 (1):139–161. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lowe J. Health equity research: A new, ongoing series in nursing research. Nursing Research. 2015; 64 (1):1–2. [ PubMed ] [ Google Scholar ]
• Meier B.M. Human rights in the World Health Organization: Views of the Director-General candidates. Health and Human Rights Journal. 2017; 19 (1):293–298. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Merriam-Webster Inequality. https://www.merriam-webster.com/dictionary/inequality (n.d.)
• National Academies of Sciences, Engineering, and Medicine . Communities in action: Pathways to health equity. The National Academies Press; 2017. 2. The state of health disparities in the United States; pp. 57–97. [ CrossRef ] [ Google Scholar ]
• National Academies of Sciences, Engineering, and Medicine . The National Academies Press; 2019. Criteria for selecting the Leading Health Indicators for Healthy People 2030. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• National Human Genome Research Institute About cystic fibrosis. 2013. https://www.genome.gov/Genetic-Disorders/Cystic-Fibrosis
• National Human Genome Research Institute About sickle cell disease. 2016. https://www.genome.gov/Genetic-Disorders/Sickle-Cell-Disease
• National Institutes of Health Estimates of funding for various research, conditions, and disease categories (RCDC) 2018. https://report.nih.gov/categorical_spending.aspx
• Oxford English Dictionary. (n.d.). Inequity, n. https://www-oed-com.ezproxy.lib.umb.edu/view/Entry/94981?redirectedFrom=inequity#eid .
• Robert Wood Johnson Foundation Catalysts for change: Harnessing the power of nurses to build population health in the 21st century. Executive summary. 2017. https://www.rwjf.org/en/library/research/2017/09/catalysts-for-change--harnessing-the-power-of-nurses-to-build-population-health.html
• Secretary'’s Advisory Committee for Healthy People 2030 . U.S. Department of Health and Human Services; 2018. Issue briefs to inform development and implementation of Healthy People 2030: Submitted to the Secretary of the U.S. Department of Health and Human Services. [ Google Scholar ]
• Sickle Cell Disease Association of America Annual Report 2017. 2018. https://www.sicklecelldisease.org/files/sites/181/2019/08/SCDAA-Annual-Report-2017.pdf
• Smith L.A., Oyeku S.O., Homer C., Zuckerman B. Sickle cell disease: A question of equity and quality. Pediatrics. 2006; 117 (5):1763–1770. doi: 10.1542/peds.2005-1611. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Steinberg M.H., Sebastiani P. Genetic modifiers of sickle cell disease. American Journal of Hematology. 2012; 87 (8):795–803. doi: 10.1002/ajh.23232. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stokes E.K., Zambrano L.D., Anderson K.N., Marder E.P., Raz K.M., Felix S.E.B.…Fullerton K.E. Coronavirus disease 2019 case surveillance — United States, January 22–May 30, 2020. Morbidity and Mortality Weekly Report. 2020; 69 (24):759–765. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Substance Abuse and Mental Health Services Administration Double jeopardy: COVID-19 and behavioral health disparities for Black and Latino communities in the U.S. 2020. https://www.samhsa.gov/sites/default/files/covid19-behavioral-health-disparities-black-latino-communities.pdf
• U.S. Bureau of Labor Statistics Labor force characteristics by race and ethnicity, 2018. 2019. https://www.bls.gov/opub/reports/race-and-ethnicity/2018/home.htm
• U.S. Census Bureau Quick facts: United States. Table. 2020. https://www.census.gov/quickfacts/fact/table/US/PST045219
• Whitehead M. A typology of actions to tackle social inequalities in health. Journal of Epidemiology and Community Health. 2007; 61 (6):473–478. doi: 10.1136/jech.2005.037242. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• World Health Organization Health systems: Equity. 2020. https://www.who.int/healthsystems/topics/equity/en/
• World Health Organization, Commission on Social Determinants of Health Closing the gap in a generation: Health equity through action on the social determinants of health. CSDH final report. 2008. http://bibliodigital.saludpublica.uchile.cl:8080/dspace/bitstream/handle/123456789/222/OMS_Subsanar%20English.pdf?sequence=1
• Young T.K. 2nd ed. Oxford University Press; 2004. Population health: Concepts and methods. [ Google Scholar ]

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The Sociology of Health Inequalities

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Dorothy Broom, The Sociology of Health Inequalities, Health Promotion International , Volume 15, Issue 2, June 2000, Pages 179–180, https://doi.org/10.1093/heapro/15.2.179

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A substantial body of research documents the socioeconomic ‘gradient’ in which worse health outcomes are associated with lower positions in the hierarchies of income, education and occupational status. The Black report ( Black, 1980 ) was not the first major work to address this issue, but it was a milestone, and since it appeared, publishing on the topic has increased considerably, beginning with a trickle during the 1980s and becoming a flood since the mid 1990s. In the circumstances of such heightened interest and output, edited collections become both inevitable and necessary. The volume under review joins (at least) two others, also high quality, published in the last two years [( Keating and Hertzman, 1999 ): see review this issue ( Marmot and Wilkinson, 1999 )].

The editors' thoughtful, clear introductory essay acknowledges the intellectual and political history of health inequalities research, and sketches the developments and debates within which the chapters are located. The Black report confirmed that economic barriers to medical services were not the cause of inequalities in health outcomes. Subsequent research—especially longitudinal—has shown that the gradient is not simply an artefact of data collection, that it is not narrowing over time, and that selection does not explain what are complex interactions.

The first substantive section of the book contains four papers on ‘understanding the social dynamics of health inequalities’. Most of the chapters in this section grapple with research showing how health inequalities prevail throughout the SES spectrum, not only among those suffering absolute material deprivation. Elstad's ‘Psycho-social perspective’ proposes a theoretical model to account for observed patterns of inequalities, linking the large literature on the health effects of stress with work on the quality of social relationships and concepts of self-efficacy. His perspective links directly with the paper by Wilkinson, Kawachi and Kennedy who are well-known contributors to this discourse. Here they use data on US state crime rates and social capital to examine the nature of the social relationships (of competition, disrespect and shame) that give rise to violent crime which are, they suggest, closely connected to the psychosocial sources of ill health.

The other two chapters in the first section mobilize a somewhat different (but not necessarily conflicting) approach. Popay and colleagues summarize the Whitehead/Dahlgren model of concentric rings of influences on health inequalities, working from biological factors at the centre through individual and social influences to broad socioeconomic, environmental and cultural dimensions. I particularly warmed to their critique of the ‘profoundly non-social' approaches which continue to add ever ‘more social variables to an increasingly long list of risk factors' (p. 69). Usefully, however, their critique does not set up antagonistic dichotomies, but calls for an integration of the individual and the social, agency and structure, micro and macro.

In the title of their chapter, Curtis and Jones ask whether there is ‘a place for geography in the analysis of health inequality’, and supply abundant rich evidence for an affirmative answer. They distinguish compositional and contextual effects, carefully disentangling the fact that similar people may live in the same neighbourhood (composition) from the possibility that the social and physical environment (context) contributes to the health of individuals within that environment.

That chapter lays the groundwork for the book's second section on ‘social and spatial inequalities in health’. In ‘Changing the map: health in Britain 1951–1991’, Shaw, Dorling and Brimblecombe show that the persistent and rising mortality gap cannot be explained by class alone. Nettleton and Burrows describe the psychological and health consequences of the onset of mortgage debt and resulting housing insecurity, thus elaborating in detail one potential process contributing to patterned inequalities in health.

Two chapters call welcome attention to the ‘complexity’ of social categories. Nazroo's research on race/ethnicity constitutes a challenge to surveys and routine statistical collections which adopt a ‘tick box’ approach to the classification of ethnicity. He calls for a focus on ethnic identity which produces a much more intelligible analysis of the link between ethnicity and health because it considers such factors as the experience of racism and ghettoization. Similarly, Cameron and Bernardes' study of prostate disease locates the multiplicity concealed within the falsely unitary categories of gender. Deficiencies in the conceptualization and measurement of the basic categories (class, ethnicity, gender) must be overcome if research is to advance and inform practical policy responses to health inequalities. After all, the notion of ‘difference’ lies at the heart of any discourse in this field, and if our thinking around these fundamental concepts is inadequate, the data will not make sense and resulting policy recommendations are likely to be off the mark.

In its incarnation as a journal issue, this book contained no thematic sections. If there is an intellectual weakness in the collection, it is that the sections—particularly the first—do not hang together entirely comfortably. The move from journal to book also resulted in deletion of the abstracts which can be helpful, particularly for such complex and subtle material. As far as I can discern, the book and journal issue are otherwise identical except for a short index, repagination and the unfortunate omission of Bernardes' name from the book's contents page.

A frustration for consumers of this literature is its comparative parochialism, both national and intellectual. Fortunately, this collection is somewhat more cosmopolitan than usual. While most contributors to the book are from English universities, there are also Dutch and Norwegian authors, although the only American names are co-authors with Wilkinson (who is from Sussex). That might not matter if more people read and thought carefully about work from other nations and intellectual traditions. Some participants in these debates advocate strongly held ideological positions which may undermine their capacity to consider the implications other perspectives might have for their own research and policy preferences. As I have threaded my way through the books, reports and journals, I have occasionally wondered whether contesting authors are sometimes addressing different issues rather than arriving at different answers to the same question. Fortunately, this book contains a minimum of ideological rhetoric and a maximum of open-mindedness and inter-disciplinary flexibility with no compromise on intellectual or empirical rigour or loss of commitment to constructive change.

Many observers believe that policy decisions of the 1990s have contributed to widening health as well as income gaps. The UK is now striving to formulate concrete policy responses ( Acheson et al ., 1998 ) to the evidence available now ( Wilkinson and Marmot, 1998 ) while it continues to invest in further research. The US National Institutes of Health have also committed significant research funding to inequalities in health. Bartley, Blane and Davey Smith's collection is a timely and welcome contribution which will be valuable for researchers and graduate students in public health and sociology. Writing from Australia, it remains to be seen whether this country will also invest substantially in research of this kind, and, over the longer term, whether policy interventions can make a positive difference.

M. Bartley, D. Blane and G.Davey Smith (eds), Blackwell Science, Oxford, 1998 (Also published as Volume 20, Number 5, Sociology of Health & Illness)

Acheson, D., Barker, D., Chambers, J., Graham, H. and Marmot, M. (1998) Independent Inquiry into Inequalities in Health: Report. The Stationery Office, UK.

Black, D. (1980) Inequalities in Health: Report of a Research Working Group. DHSS, London.

Keating, D. P. and Hertzman, C. (eds) (1999) Developmental Health and the Wealth of Nations: Social , Biological , and Educational Dynamics. Guilford Press, New York.

Marmot, M. and Wilkinson, R. G. (eds) (1999) Social Determinants of Health. Oxford University Press, Oxford.

Wilkinson, R. and Marmot, M. (eds) (1998) Social Determinants of Health: The Solid Facts. World Health Organization, Geneva.

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