title: Persistence of social inequalities in modern welfare states: Explanation of a paradox.
abstract: OBJECTIVE
  Social-epidemiological explanations of health inequalities usually take the existence of social inequality as a given and ignore the fundamental questions of why social inequality exists in the first place and why it is so persistent. I review here theories of the explanation of social inequality to identify the processes and/or structures responsible for its persistence.
  
  
  METHODS
  This paper is a review of the relevant sociological literature.
  
  
  RESULTS
  The sociological literature suggests that what persists over long periods of time is not a specific manifestation of social inequality but a 'meta-phenomenon': the fact that there are different social positions, that these social positions give access to different levels of resources in some graded way and that the distribution of individuals over social positions follows rules that create inequalities in the opportunities for achieving a more advantaged social position. The durability of social inequality in this generic form can then be understood from the persistence of the underlying mechanisms and processes - for example, humans are driven by self-interest, while most objects of their striving are in short supply, therefore a struggle for rewards is present in all societies; humans are unequally endowed, therefore some are more successful in this struggle for resources than others; and the inequalities resulting from these individual level actions are structurally fixated through the intergenerational transmission of (dis)advantage, various societal institutions, and cultural factors.
  
  
  CONCLUSIONS
  The sociological literature suggests that some mechanisms producing and perpetuating social inequality are more 'benign' than others. Health inequalities may be more than a consequence of social inequality and may play a more profound part by amplifying social inequalities.
authors.affiliation: Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D054624:Health Status Disparities; D006801:Humans; D012537:Scandinavian and Nordic Countries; D066269:Social Theory; D012946:Social Welfare; D012959:Socioeconomic Factors
keywords: Health inequalities; conflict theories; ecological-evolutionary theory; functionalist theories; persistence; social inequality