Health inequalities today are unfair or unjust differences in health determinants or outcomes within or between defined populations.

Determinants are the causes and influences; outcomes  are diseases and states of health

Health services are  thought to influence about 30-40% of  health status

Life expectancy

Life expectancy at birth across the world

Unfair or unjust differences in health determinants:

The world’s richest 85 people have a combined net worth of US$110 trillion – equal to the total assets of the poorest 50 percent of the world’s population: about 3.5 billion people

Unfair or unjust differences in health outcomes in England
– all cause mortality (in under 75s), 2006-08


Mortality in England

Mortality in England

Life expectancy in London

Life expectancy in London

Age standardised mortality rates by region and National Statistics Socio-economic Classification

Age standardised mortality rates by region and National Statistics Socio-economic Classification

Public policy determinants of health inequalities today:

  • Economy
  • Social security
  • Agriculture
  • Food
  • Environment
  • Transport
  • Housing
  • Employment
  • Health care
  • Social services
  • Education
  • Crime
  • Discrimination
  • Arts
  • Leisure
  • Recreation
  • Defence

Inequalities in what?


  • Mortality
  • Morbidity
  • Well-being

Health care

  • Access – physical / financial / opportunity cost
  • Quality – clinical / process

‘Wider’ determinants of health

  • Structural
  • Cultural / behavioural
  • Environmental

Health determinants act at multiple levels


Socioenvironmental approach to health

Health equity (fairness in health) could be described as

…from each according to his abilities, to each according to his needs…

Karl Marx, Critique of the Gotha Programme (1875)

Distributional justice: Inequity in policy (eg positive action / discrimination)  is required to achieve  equality of outcome


Total life expectancy and GDP for 209 countries in 1997:

Source: World Bank’s World Development Indicators 2000. Life expectancy is for both males and females, in years, from birth. GDP figures are in international dollars, which use purchasing power parity in order to provide a standard measure of real price levels between countries.

Presented at our policy seminar June 2016

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