New perspectives on socioeconomic inequalities in health.
In all countries with available data, risks of disease and premature death tend to be systematically higher for those with lower levels of education and income. During the 1990s, substantial progress has been made in understanding the mechanisms and factors involved in generating these variations in health. What has emerged from recent research efforts is a rather complex picture of how individuals in the lower socioeconomic strata are exposed over their lifetime to a wide variety of unfavorable and interacting material, cultural, and psychological conditions, and how these exposures lead to ill-health-either directly, or indirectly through unhealthy behaviors or psychosocial stress. This research has opened a number of new perspectives which we review here: life-course perspectives (dealing with the clustering of advantage and disadvantage over an individual's lifetime), biological perspectives (dealing with the biological mechanisms that bring socioeconomic disadvantage under the skin), macrosocial perspectives (dealing with the effect of the wider social, economic, and political environment), and policy perspectives (dealing with the implications of research findings for the development of effective strategies to reduce inequalities in health).
Mackenbach
Johan P
JP
Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl
Howden-Chapman
Philippa
P
D019049:Developed Countries; D004522:Educational Status; D014943:Global Health; D006291:Health Policy; D006293:Health Promotion; D006305:Health Status Indicators; D006801:Humans; D007182:Income; D012931:Social Environment; D012935:Social Justice; D012959:Socioeconomic Factors