Health inequalities: Persistence and change in modern welfare states

ISBN : 9780198831419

Johan Mackenbach
252 ページ
171 x 246 mm

The world we live in is hugely unequal.
People in a better socioeconomic position do not only lead more comfortable lives, but also longer and healthier lives. This is true not only in the poorer parts of the world but also in the richest countries, including the advanced welfare states of Western Europe which have successfully pushed back poverty and other forms of material disadvantage. Why are health inequalities - systematically higher rates of disease, disability, and premature death among people with a lower level of education, occupation or income - so persistent? How can we expect to reduce this when it persists even in the most advanced states?
Written by a leading figure in public health, this book looks to answer these questions by taking a broad, critical look at the scientific evidence surrounding the explanation of health inequalities, including recent findings from the fields of epidemiology, sociology, psychology, economics, and genetics. It concludes that a simplistic view, in which health inequalities are a direct consequence of social inequality, does not tell us the full story. Drawing upon a unique series of studies covering 30 European countries and more than three decades of observations, it shows that health inequalities are partly driven by autonomous forces that are difficult to counteract, such as educational expansion, increased social mobility, and rapid but differential health improvements. Finally, the book explores how we might use these new findings to continue our efforts to build a healthier and more equal future.
Offering a truly multidisciplinary perspective and an accessible writing style, Health Inequalities is an indispensable resource for health researchers, professionals, and policy-makers, as well as for social scientists interested in inequality.


Chapter 1. Introduction
More illness within shorter lives
The great paradox of public health
The need for a broader picture
Preview: this book's main conclusions
Chapter 2. Patterns of health inequalities
Measurement issues
Generalized, but uneven
Persistent, but dynamic
Ubiquitous, but variable
Health inequalities outside Europe
Chapter 3. Explanatory perspectives
Methodological issues
Education, occupation, income and health
Six groups of contributing factors
Theories about the explanation of health inequalities
Chapter 4. Patterns of health inequalities explained
Set-up of the analyses
Changes in social stratification
Rapid but differential health improvements
Differential effects of factors driving population health change
Continued social patterning of health determinants
Understanding the European experience
Chapter 5. A broader picture
Why social inequality persists in modern welfare states
Health inequalities and welfare state reform
Health inequalities and social justice
Chapter 6. Policy implications
Proposals for tackling health inequalities
National attempts at tackling health inequalities
Realistic expectations
Final reflections


Johan Mackenbach is Professor of Public Health at the Department of Public Health at the Erasmus MC, University Medical Center Rotterdam, the Netherlands. He is also a Honorary Professor at the London School of Hygiene and Tropical Medicine, and an elected member of the Royal Netherlands Academy of Science and the Academia Europaea. His research interests are in social epidemiology, medical demography and health policy. He has (co-)authored around 700 papers as well as a number of books. He is a former editor-in-chief of the European Journal of Public Health. Throughout his career, he has been actively engaged in exchanges between research and policy, among others, as a member of the Health Council and the Council for Public Health and Health Care, both of the Netherlands. He received a Doctorate Honoris Causa at the Universite Catholique de Louvain (Belgium), and has been elected as a Honorary Fellow of the Faculty of Public Health by the Royal Colleges of Physicians of the United Kingdom.