Why Are Health Inequalities So Hard to Fix? The Political and Institutional Determinants of A Policy Failure

The paper argues that domestic institutions and norms refract the SES-centric approach to resolving health inequalities, so that in different national contexts emphasis is placed on forms of inequality that are least politically problematic.  This allows policy-makers to use the health inequalities framework to construct largely consensual programs to deal with politically salient aspects of social inequity. However, I find that despite this malleability, the health inequalities frame, once adopted, tends to foreclose opportunities for policy reforms farther "upstream" that would result in real improvements in population health.  Among the advanced industrial democracies, only Finland has escaped this trap.