The Social Sources of Health Inequalities

Although inequalities in health are ubiquitous, the shape of the gradient linking health to socioeconomic position varies across countries.  This paper documents variations in the health gradient across the developed democracies and assesses the value of a capabilities approach to population health for explaining those differences.  In contrast to analyses that associate health inequalities with the distribution of income or collective lifestyles, this approach locates their sources in features of the national structure of social and economic relations that condition people’s capabilities for coping with life challenges.  Such a perspective links national variation in health inequalities to systematic differences in national systems of social stratification and varieties of capitalism.  The paper elaborates this perspective and assesses its explanatory value against aggregate data for 18 nations drawn from the 1990 and 2005 World Values Surveys.  It suggests that inequalities in health are rooted in systematic differences across nations in the structure of socioeconomic relations and that policies addressing those inequalities will be more effective if they address those relations.