OXFORD UNIVERSITY PRESS, JULY 2013Socioeconomic disparities in health are among the most troublesome and refractory problems in medicine. Simply put, poor, disadvantaged, or marginalized people have poorer health and shorter life expectancies than do rich or more privileged people. The cause of these health disparities is hotly debated. People who have poor health may be unable to work, or unable to work at higher skilled or higher paying jobs, and so poor health may sometimes lead to poverty, but this factor must account for only a small fraction of the association between poverty and health. In countries such as the United States, disparities in access to health care may contribute to health disparities but this too must be only a small part of the problem, because health disparities exist in countries such as the United Kingdom, which has a national health service and in which there is less inequality in access to health care. Absolute levels of poverty compromise health and longevity in the poorest countries in the world, where life expectancy is correlated with the per capita gross national product, but poverty alone does not account for the health disparities in developed countries. The epidemiologists Michael Marmot and Richard Wilkinson have been the most forceful proponents of the view that socioeconomic inequalities themselves are the cause of inequalities in health.
Some of the most comprehensive and best-documented studies of health disparities have been carried out in the United Kingdom. The U.K. Office for National Statistics classifies occupations into seven socioeconomic classes, ranging from “1. Higher professional and higher managerial” (senior government officials, physicians, scientists, etc.) to “7. Routine” (occupations such as bus drivers and domestic workers), and analyzes health disparities in terms of this occupation-based scale. An ongoing longitudinal study of the U.K. population has documented a socioeconomic gradient in life expectancy. In the period from 1982–86, men in class 1 had a life expectancy of 75.6 years while men in class 7 had a life expectancy of 70.7 years. In the period from 2002–06, life expectancy of these groups increased to 80.4 and 74.6 ...
