Inequalities in health

Inequalities in Health

Annandale and Field (2008) argue:

“Inequalities in health between social groups are a resilient feature of British society and continue to be part of the social and political landscape of the 21st century”.

1. Consider you position on this question:

“Does Poverty and ill health arise from the failings of individuals or from failings of society”?


Write some first thoughts on this question and share with colleagues:

Consider what evidence you have for your position, can you refer to any?


Historical milestones:


Townsend, P. (1988) Inequalities in Health (The Black Report). Penguin. London.   What was its main conclusion?


That the main explanation for inequalities ‘was material deprivation’. The social environment which includes things like family size, unemployment, housing, income.


Acheson Report (1998). What did this report conclude?


Concurred with the Black report, and that the gap between top and bottom has widened. 



The Wanless Report (2008) ‘Layers of influence’, meaning what?


Combines lifestyle, behaviours and environmental explanations.


In November 2008, Professor Sir Michael Marmot was asked by the Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The strategy includes policies and interventions that address the social determinants of health inequalities.

The Review had four tasks: 

  1. Identify, for the health inequalities challenge facing England, the evidence most relevant to underpinning future policy and action
  2. Show how this evidence could be translated into practice
  3. Advise on possible objectives and measures, building on the experience of the current targets on infant mortality and life expectancy
  4. Publish a report of the review’s work that will contribute to the development of a post-2010 health inequalities strateg

The Marmot Review (2010)


1. Go to the  Fairer Society Healthy Lives website. Find the executive summary



·        What are the key messages of the review? Explain in your own words.

·        How many policy objectives are there?

·        What are the key points from each?



2. Go to Marmot Indicators for local authorities (see above page)

a) South West in ‘select your region’, then select ‘Cornwall’

b) Do the same for Northeast and Newcastle, London and Hackney, London and Kensington and Chelsea.

c) open the pdfs…what are you looking at? Compare the data sets.

What explanations are given for the inequalities in health?

See Annandale and Field (2008) in Chapter 3 of Taylor, S. and Field, D. (2008) Sociology of Health and Health care. 4e Blackwell Oxford.

Or Inequalities in health, contested spaces

·         Outline the explanations in your own words:

1.       Heriditarian explanations: one’s biologically determined natural capacity, thus little can be done.

2.       Behavioural explanations: the lifestyle choices of individuals are the cause the answer is education (or punishment)

3.       Environmental explanations: one’s social position and material deprivation, the answer is structural.

 So, either individualistic/behaviourist and/or structural/materialist.

Contemporary explanations: there are overlaps, this is a simplified typology.

1.       Poverty/deprivation (structuralist/materialist – environmental).

2.       Psycho-social stress (structuralist/materialist – environmental -behavioural).

3.       Individual deficits (individualist/behavioural – hereditarian).


1.       ‘RED, MUD and SID’ – Redistribution, Moral Underclass and Social Integrationist discourses

2.       Work is needed at individual and/or community and /or social structure level.


Carlisle, S.  (2001) Inequalities in Health: contested explanations, shifting discourses and ambiguous polices. Critical Public health 11 (3)





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