health inequalities

The Lancet, Volume 375, Issue 9711, Pages 274 - 275, 23 January 2010

Who owns health inequalities?

Constance A Nathanson a

Health inequalities are old news—very old news. John Graunt's analysis of the English Bills of Mortality, statistically documenting the fact of inequality in death, was published in the mid-17th century. Beginning early in the 19th century, death rates by occupation compiled by the Registrar General's Office in London left no doubt that those in the bottom ranks died at substantially higher rates than those at the top. At much the same time, French scholars concluded that the condition most closely associated with an early death was poverty, basing their findings on a series of remarkable studies published in the first public health journal, Annales d'hygiène publique. The facts of inequality in disease and death were well known before the beginning of the 20th century. Their perennial rediscovery in the years since has little to do with lack of knowledge and much to do with heated (and value-laden) disagreement among scholars, bureaucrats, and politicians about why inequalities exist, what should be done about them, and who should do it. By their nature, these questions are interrelated. Inequalities attributed to sinful indulgence in wine and women are much less likely to interest penny-pinching public authorities than those attributed, for example, to the handle on the Broad Street pump./.../