PHM-Exch> Who owns health inequalities?

[Claudio Schuftan]

From: Vern Weitzel <vern.weitzel at gmail.com>
crosposted from: "[health-vn discussion group]" health-vn at anu.edu.au


*Who owns health inequalities?


Constance A Nathanson, Mailman School of Public Health, Columbia
University, New York USA

*The Lancet, Volume 375, Issue 9711,  23 January 2010


Website:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60119-5/fulltext




“…..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…..”

“…..Are health “inequalities” a problem of the poor (and thus soluble by
changing poor people's circumstances or behaviour) or are they an effect
of rigid patterns of social stratification (requiring that resources be
redistributed)? Are they “voluntary”—the result of bad choices (“booze
and fags”)—or “involuntary”—the consequence of oppressive social
structures? Should inequalities be framed as “disparities”—mere
differences that may or may not be the result of human action—or as
unacceptable “inequities”?

And finally, who “owns” health inequalities? Are they—as in the 19th
century—a public health problem or are they a medical care problem? Are
they a private problem or a public problem? These are not logical or
empirical questions. They are political questions. How they are answered
will depend on the policy preferences of those in power, or who aspire
to power. I illustrate these points with the examples of the UK and the
USA, countries at the extremes of public policy in this domain…..”
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