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Chapter 6 - Poverty, Inequality, and Health

from Section 1 - Social Exclusion, Poverty, and Inequality

Published online by Cambridge University Press:  24 November 2022

Jed Boardman ,
Helen Killaspy  and
Gillian Mezey
Jed Boardman
Affiliation:
King's College London
Helen Killaspy
Affiliation:
University College London
Gillian Mezey
Affiliation:
St George's Hospital Medical School, University of London
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Summary

This chapter examines the changes in economic inequalities in the UK and internationally along with the links between poverty and inequality. We outline the way in which health and illness are distributed in the population and the psychosocial factors that operate to create and maintain health inequalities. Poverty and economic inequality are intrinsically and instrumentally related. Both are relevant to deprivation, violate human dignity, hinder social and health goals, and fluctuate in populations in a correlated manner. Health and illness are socially patterned in the same way as we saw for the experience of poverty, and are related to social class and status. Health and ill-health are determined not only by biological mechanisms, but also by a series of upstream factors which are material, psychological, social, and political – that is, by the ‘causes of the causes’. The examination of poverty, economic inequality and health inequalities reveal psychological, social, economic, and political factors that can help us to develop a firmer understanding of the social exclusion of people with mental health conditions as well as important aspects of public mental health.

Keywords

PovertyEconomic inequalityGini Co-efficientWealthIncomeHealth InequalitiesSocial DeterminantsSocial ClassSocio-Economic Status
Type
Chapter
Information
Social Inclusion and Mental Health
Understanding Poverty, Inequality and Social Exclusion
 , pp. 116 - 140
Publisher: Cambridge University Press
Print publication year: 2022

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References

Aldridge, R. W., Story, A., Hwang, S. W., et al. (2017) Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet; published online 11 Nov. http://dx.doi.org/10.1016/S0140-6736.Google Scholar
Alvaredo, F., Cancel, L., Piketty, T., et al. (2018), World Inequality Report 2018, World Inequality Lab. http://wir2018.wid.world/files/download/wir2018-full-report-english.pdfGoogle Scholar
Atkinson, A. B. (2015) Inequality: What Can Be Done? Harvard University Press.Google Scholar
Balestra, C. and Tonkin, R. (2018) Inequalities in household wealth across OECD countries: Evidence from the OECD Wealth Distribution Database. Working Paper No.88. OECD Publishing.Google Scholar
Barker, D. J. P. (1990) Fetal and infant origins of adult disease. BMJ. 301, 6761, 1111. https://doi.org/10.1136/bmj.301.6761.1111.Google Scholar
Bartley, M. (2017) Health Inequality: An Introduction to Concepts, Theories and Methods. 2nd ed. Polity Press.Google Scholar
Bartley, M., Power, C., Blane, D., Davey Smith, D., & Shipley, M. (1994) Birth weight and later socioeconomic disadvantage: evidence from the 1958 British cohort study. BMJ 309, 1475–9.Google Scholar
Benzeval, M., Bond, L., Campbell, M., et al. (2014) How Does Money Influence Health? Joseph Rowntree Foundation.Google Scholar
Booth, R. (2010) Spirited defence: How ‘ideas wreckers’ turned bestseller into political punchbag. The Guardian, 14 August, p. 3.Google Scholar
Bucelli, I. (2017) Inequality, poverty and the grounds of our normative concerns, CASE paper 204/LIP paper 1. Centre for Analysis of Social Exclusion, LSE.Google Scholar
Burchardt, T. & Hick, R. (2018) Inequality, advantage and the capability approach. Journal of Human Development and Capabilities, 19, 1, 38–52. https://doi.org/10.1080/19452829.2017.1395396.CrossRefGoogle Scholar
Chan, T. W. & Goldthorpe, J. H. (2004) Is there a status order in contemporary British society? Evidence from the Occupational Structure of Friendship. European Sociological Review 20, 383–401.Google Scholar
Chan, T. W. & Goldthorpe, J. H. (2007) Class and status: The conceptual distinction and its empirical relevance. American Sociological Review 72, 512–32.Google Scholar
Cream, J., Fenney, D., Williams, E., et al. (2020) Delivering Health and Care for People Who Sleep Rough: Going Above and Beyond. London: King’s Fund.Google Scholar
CSDH (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.Google Scholar
Davey Smith, G. & Krieger, N. (2008) Tackling health inequities. BMJ 337: a1526CrossRefGoogle ScholarPubMed
Deaton, A. (2013) The Great Escape: Health, Wealth, and the Origins of Inequality. Princeton University Press.Google Scholar
Dent Coad, E. (2020) After Grenfell: Housing and inequality in Kensington and Chelsea: The most unequal borough in Britain. 2017. https://justice4grenfell.org/wp-content/uploads/2017/11/364307729-After-Grenfell.pdf.Google Scholar
Dorling, D. (2010) Injustice: Why Social Inequality Persists. Policy Press.Google Scholar
Dorling, D. (2014) Inequality and the 1%. Verso.Google Scholar
Dorling, D., Rigby, J., Wheeler, B., et al. (2007) Poverty, Wealth and Place in Britain 1968 to 2005. Joseph Rowntree Foundation. Policy Press.Google Scholar
Dorling, D., Mitchell, R., Shaw, M., Orford, S. & Davey Smith, G. (2000) The Ghost of Christmas Past: The health effects of poverty in London in 1896 and 1991. British Medical Journal, 321, 1547–51.Google Scholar
Elgar, F. J. (2010) Income inequality, trust, and population health in 33 countries. Am J Public Health 100, 2311–15. https://doi.org/10.2105/AJPH.2009.189134.Google Scholar
Frankfurt, H. G. (1987) Equality as a moral ideal. Ethics, 98, 1, 21–43.Google Scholar
Goldthorpe, J. H. (2010) Analysing social inequality: A critique of two recent contributions from economics and epidemiology. European Sociological Review, 26, 6, 731–44. https://doi.org/10.1093/esr/jcp046.Google Scholar
Goldthorpe, J. H. (2013) Understanding – and misunderstanding – social mobility in Britain: The entry of the economists, the confusion of politicians and the limits of educational policy. Jnl Soc. Pol. 42, 3, 431–50.CrossRefGoogle Scholar
Hacking, J. M., Muller, S., & Buchan, I. E. (2011) Trends in mortality from 1965 to 2008 across the English north-south divide: Comparative observational study. BMJ 342, d508. https://doi.org/10.1136/bmj.d508.CrossRefGoogle ScholarPubMed
Hardoon, D. Ayele, S., & Fuentes-Nieva, R. (2016) An Economy for the 1%. Oxfam Briefing Paper. Oxfam.Google Scholar
Hills, J., McKnight, A., Bucelli, I., et al. (2019) Understanding the relationship between poverty and inequality. Overview report. Case Report No. 119 Lip Paper 10. LSE, Centre for Analysis of Social Exclusion (CASE).Google Scholar
Ho, J. Y. & Hendi, A. S. (2018) Recent trends in life expectancy across high income countries: Retrospective observational study. BMJ 362: k2562. http://dx.doi.org/10.1136/bmj.k2562Google Scholar
King’s Fund (2021) What are health inequities? www.kingsfund.org.uk/publications/what-are-health-inequalitiesGoogle Scholar
Kriznik, N. M, Kinmonth, A. L, Ling, T., & Kelly, M. P. (2018) Moving beyond individual choice in policies to reduce health inequalities: The integration of dynamic with individual explanations. Journal of Public Health 40, 4, 764–75.Google Scholar
Lansley, S. & Mack, J. (2015) Breadline Britain: The Rise of Mass Poverty. London: One World.Google Scholar
Layte, R., & Whelan, C. T. (2014) Who feels inferior? A test of the status anxiety hypothesis of social inequalities in health. European Sociological Review 30, 4 525–35. https://doi.org/10.1093/esr/jcu057.CrossRefGoogle Scholar
Lynch, J. W., Davey Smith, G., Kaplan, G. A. & House, J. S. (2000) Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. BMJ 320, 1200–4.Google Scholar
Lynch, J. W., Kaplan, G. A. Cohen, R. D., Tuomilehto, J., & Salonen, J. T. (1996) Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol 15,144, 10,934–42. https://doi.org/10.1093/oxfordjournals.aje.a008863.Google Scholar
Ma, J., Xu, J., Anderson, R. N., & Jemal, A. (2012) Widening educational disparities in premature death rates in twenty six states in the United States, 1993–2007. PLoS ONE 7, 7, e41560. https://doi.org/10.1371/journal.pone.0041560.Google Scholar
Mackenbach, J. P. (2009) Politics is nothing but medicine at a larger scale: Reflections on public health’s biggest idea. J Epidemiol Community Health. 63, 3, 181–4. (See also: J Epidemiol Community Health. 2006 Aug; 60(8): 671. Aphorism of the Month: Virchow misquoted, part‐quoted, and the real McCoy.)Google Scholar
Mackenbach, J. P. (2012) The persistence of health inequalities in modern welfare states: The explanation of a paradox. Social Science & Medicine 75, 2012, 761–9.Google Scholar
Marmot, M. (2015) The Health Gap. London: Bloomsbury.Google ScholarPubMed
Marmot, M. (2020) Society and the slow burn of inequality. Lancet 395, 1413–14.CrossRefGoogle ScholarPubMed
Marmot, M, Allen, J, Boyce, T., Goldblatt, P., & Morrison, J. (2020) Health Equity in England: The Marmot Review 10 Years On. London: Institute of Health Equity.Google Scholar
Marmot, M., Allen, J., Goldblatt, P., et al. (2010) Fair Society, Healthy Lives: The Marmot Review. London: Institute of Health Equity.Google Scholar
Marmot, M. G., Davey Smith, G., Stansfield, S., et al. (1991) Health inequalities among British civil servants: The Whitehall II study. The Lancet. 337, 8754, 1387–93. https://doi.org/10.1016/0140-6736(91)93068-K.Google Scholar
McCartney, G., Pophamb, F., McMaster, R., & Cumber, A. (2019) Defining health and health inequalities. Public Health 172, 22–30. https://doi.org/10.1016/j.puhe.2019.03.023.Google Scholar
McGuinness, D., McGlynn, L. M., Johnson, P., et al. (2012) Socio-economic status is associated with epigenetic differences in the pSoBid cohort. International Journal of Epidemiology 41, 151–60. https://doi.org/10.1093/ije/dyr215.Google Scholar
McKinlay, J. B. (2019) A case for refocusing upstream: The political economy of illness. IAPHS Occasional Classics, 1, November 18, 1–10 (originally published in 1975). https://iaphs.org/wp-content/uploads/2019/11/IAPHS-McKinlay-Article.pdf.Google Scholar
Mcknight, A., Duque, M., & Rucci, M. (2017) Double trouble: A review of the relationship between UK poverty and economic inequality. Research Report, Centre for Analysis of Social Exclusion, London School of Economics/Oxfam.Google Scholar
Mitchell, R., Shaw, M., & Dorling, D. (2000) Inequalities in Life and Death: What If Britain Were More Equal? The Policy Press.Google Scholar
Muntaner, C. & Lynch, J. (1999) Income inequality, social cohesion, and class relations: A critique of Wilkinson’s neo-Durkheimian research program. International Journal of Health Services, 29 (1), 59–81.Google Scholar
OECD (2011) Divided We Stand: Why Inequality Keeps Rising. OECD Publishing.Google Scholar
OECD (2015) In It Together: Why Less Inequality Benefits All. OECD Publishing.Google Scholar
Obolenskaya, P. & Hills, J. (2019) Flat-lining or seething beneath the surface? Two decades of changing economic inequality in the UK. SPDO research paper 4. London: LSE, Centre for Analysis of Social Exclusion (CASE).Google Scholar
Okun, A. M. (1975), Equality and Efficiency: The Big Tradeoff. The Brookings Institution.Google Scholar
Office for National Statistics (ONS) (2020) Deaths of Homeless People in England and Wales: 2019 Registrations. Office for National Statistics.Google Scholar
Pickett, K. E. & Wilkinson, R. G. (2015) Income inequality and health: A causal review. Social Science & Medicine 128 (2015) 316–26.CrossRefGoogle Scholar
Piketty, T. (2014) Capital in the Twenty-First Century. Harvard University Press.Google Scholar
Preston, S. H. (1975). The changing relation between mortality and level of economic development. Population Studies, 29, 2, 231–48.Google Scholar
Public Health England (2017) Psychosocial Pathways and Health Outcomes: Informing Action on Health Inequalities. Public Health England.Google Scholar
Ratcliff, K. S. (2017) The Social Determinants of Health: Looking Upstream. Polity.Google Scholar
RCPCH (2017) The state of child health report 2017. www.rcpch.ac.uk/sites/default/files/2018-05/state_of_child_health_2017report_updated_29.05.18.pdfGoogle Scholar
Reid-Henry, S. (2015) The Political Origins of Inequality. University of Chicago Press.Google Scholar
Rohwerder, B. (2016) Poverty and Inequality: Topic Guide. GSDRC, University of Birmingham.Google Scholar
Rose, G. (1992) The Strategy of Preventive Medicine. Oxford University Press.Google Scholar
Sassi, F. (2009) Health inequalities: A persistent problem. In Towards a More Equal Society? Poverty, Inequality and Policy since 1997 (ed. Hills, J, Sefton, T, & Stewart, K). Policy Press, pp. 135–55.Google Scholar
Scheve, K. & Stasavage, D. (2017) Wealth inequality and democracy. Annu. Rev. Polit. Sci. 2017. 20, 451–68.Google Scholar
Shaw, M., Davey Smith, G. & Dorling, D. (2005) Health inequalities and New Labour: How the promises compare with the real progress. BMJ, 330, 1016–21.CrossRefGoogle ScholarPubMed
Shaw, M., Dorling, D., Gordon, D., & Davey Smith, G. (2001) Putting time, person and place together: The temporal, social and spatial accumulation of health inequality, Critical Public Health, 11, 4, 289–304. https://doi.org/10.1080/09581590110098158.Google Scholar
Shildrick, T. (2018) Lessons from Grenfell: Poverty propaganda, stigma and class power. The Sociological Review Monographs 66, 4, 783–98.Google Scholar
Siegrist, J. & Marmot, M. (2006) Social Inequalities in Health: New Evidence and Policy Implications. Oxford University Press.CrossRefGoogle Scholar
Snowdon, C. (2011) The Spirit Level Delusion: Fact Checking the Left’s New Theory of Everything. Monday Books. http://spiritleveldelusion.blogspot.com/.Google Scholar
Stiglitz, J. (2013) The Price of Inequality: How Today’s Divided Society Endangers Our Future. London: Penguin.Google Scholar
Sutton Trust and the Social Mobility Commission (2019) Elitist Britain 2019: The Educational Backgrounds of Britain’s Leading People. Sutton Trust.Google Scholar
Tawney, R. H. (1913) ‘Poverty as an industrial problem’. Inaugural lecture, reproduced in Memoranda on the Problems of Poverty. William Morris Press.Google Scholar
Tinson, A. (2020) Living in Poverty Was Bad for Your Health Before COVID-19. London: The Health Foundation.Google Scholar
Tjepkema, M., Wilkins, R., & Long, A. (2013) Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study. Health Reports 24, 14–22.Google Scholar
Townsend, P. & Davidson, N. (eds.) (1982) Inequalities in Health: The Black Report. Penguin.Google Scholar
United Nations (2013) Inequality Matters. Report of the World Social Situation. United Nations.Google Scholar
United Nations (2020) World Social Report 2020. Inequality in a Rapidly Changing World. Department of Economic and Social Affairs. United Nations.Google Scholar
Weber, Max (1978). Economy and Society: An Outline of Interpretive Sociology [trans. of 1964 edn of Weber 1922], ed. Roth, Guenther and Wittich, Claus. University of California Press.Google Scholar
Wilkinson, R. G. (1994) The epidemiological transition: From material scarcity to social disadvantage. Daedalus, 123, 61–77.Google Scholar
Wilkinson, R. G. (1996) Unhealthy Societies: The Afflictions of Inequality. Routledge.Google Scholar
Wilkinson, R. (2005) The Impact of Inequality: How to Make Sick Societies Healthier. The New Press.Google Scholar
Wilkinson, R. (2006) Income inequality and health: a review of the evidence. Social Science and Medicine, 62, 1768–84.Google Scholar
Wilkinson, R. & Pickett, K. (2009) The Spirit Level: Why More Equal Societies Almost Always Do Better. Penguin.Google Scholar
Wilkinson, R. & Pickett, K. (2017) The enemy between us: The psychological and social costs of Inequality. European Journal of Social Psychology 47, 11–24.Google Scholar
Wilkinson, R. & Pickett, K. (2018) The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity, and Improve Everyone’s Wellbeing. Allen Lane.Google Scholar
Whitehead, M., & Dahlgren, G. (2006) Concepts and Principles for Tackling Social Inequities in Health: Levelling Up Part 1. WHO Regional Office for EuropeGoogle Scholar
WHO Regional Office for Europe (2014) Review of Social Determinants and the Health Divide in the WHO European Region: Final Report. WHO Regional Office for Europe.Google Scholar
World Bank (2021) Data Bank. Life expectancy at birth, total (years). https://data.worldbank.org/indicator/SP.DYN.LE00.IN.Google Scholar

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