Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities.
This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. It is argued that global and national socio-political-economic trends have increased the power of business classes and lowered that of working classes. The neo-liberal policies accompanying these trends led to increased income inequality but also poverty and unequal access to many other health-relevant resources. But international pressures towards neo-liberal doctrines and policies are differentially resisted by various nations because of historically embedded variation in class and institutional structures. Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to "go beyond" the income inequality hypothesis towards consideration of a broader set of the social determinants of health.
Coburn
David
D
Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada M5S 1A8. david.coburn@utoronto.ca
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries / Q000191:economics; D014943:Global Health; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008875:Middle Aged; D011056:Political Systems; D011057:Politics; D011203:Poverty; D012923:Social Class; D012935:Social Justice; D012959:Socioeconomic Factors; D012962:Sociology, Medical