Health inequalities explained

Why is there a 10-year difference in life expectancy between the rich and the poor? Is it time to prioritise equity over equality?

Author: Amalia Choupi
Editor: Maria Stoica
Artist: Lydia Popplewell


People of lower socioeconomic status may live up to 10 years less compared with their more affluent counterparts, in the same country. Surprisingly, this pattern is observed in countries where the health system is tax-funded and healthcare is provided free of charge to everyone without discrimination. Recognising this paradoxical situation is of utmost importance if we want to reduce worldwide discrepancies in life expectancy within and between countries. 

A positive correlation between socioeconomic status and health outcomes is well-established, since socioeconomic status is determined by factors like income, education, housing conditions and occupation. Poor housing and working conditions expose individuals to unhygienic conditions and physical risks. Moreover, an inability to buy food can lead to undernutrition and weaken the immune system. Diet quality is also linked to socioeconomic status, as people of lower socioeconomic status often choose energy-dense foods high in refined sugars, salts and fats to maximise their caloric intake and minimise cost. 

Education is also a determinant of socioeconomic status, that is critical for explaining the persistence of health inequalities in the developed world. Education is powerful in shaping attitudes and lifestyles choices. For example, learning the adverse effects of smoking on health can significantly impact one’s stance towards it. In countries with a free meritocratic education system, individuals’ progression will depend on themselves and not on their wealth. However, since we are all different, we cannot all thrive in the same system. For example, if grades only depended on group work, those who work better on their own would not produce the same results with people who perform better in groups. The ones who advance academically are more likely to  end up in a high socioeconomic class, resulting in a lower socioeconomic class composed of people with behaviours that promote ill-health. Maybe it is high time we focus on equity instead of equality, achieved in this case by a free education system. Designing an education system that accommodates and cultivates personal differences could allow more individuals to progress academically and adopt healthy behaviours and lifestyles. 

Maybe the rigidity of the system and not differences in wealth that are causing differences in health outcomes. Therefore, those in power may need to shift their attention away from wealth as money per se, which is one of the reasons that developed countries have failed to reduce health inequalities, and focus on the impact of wealth on behaviours, if they do not want the poor to suffer from diseases the wealthier are not.

References

https://www.worldometers.info/demographics/life-expectancy/

Darmon, N. and Drewnowski, A. (2008). Does social class predict diet quality?. The American Journal of Clinical Nutrition, 87(5), pp.1107-1117.

Mackenbach, J. (2012). The persistence of health inequalities in modern welfare states: The explanation of a paradox. Social Science & Medicine, 75(4), pp.761-769.

Øversveen, E. and Eikemo, T. (2018). Reducing social inequalities in health: Moving from the ‘causes of the causes’ to the ‘causes of the structures’. Scandinavian Journal of Public Health, 46(1), pp.1-5.

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