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Inequality -- it's not all just in the head


Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions

Policies to reduce inequalities in health should not confuse the structural causes of inequality with their subjective consequences, says an article in this week's BMJ.

Lynch and colleagues from the Universities of Michigan and Bristol analysed the evidence for a link between income inequalities and health using three different published interpretations: differences in individual income; psychosocial environmental factors; and neo-material considerations.

The authors use the metaphor of plane travel: a psychosocial interpretation holds that Economy class travellers have worse health after a flight than First class travellers because of the negative emotions engendered from knowing that the First class passengers are having a better time of it; abolishing the different classes of travel would solve the problem. The neo-material approach holds that Economy travellers have worse health simply because they have cramped seats and can't sleep; upgrading conditions in Economy class would take care of that.

Although psychosocial factors cannot be dismissed, conclude the authors, it is hard to see how these could inform public policy to reduce health inequalities. But a combination of income differentials and material conditions recognises the impact of political and economic processes on individual income and subsequently on personal and public resources, such as healthcare, education, social welfare and working conditions. The authors conclude that strategies to ensure more equitable distribution of public and private resources would do most to reduce health inequalities and improve public health in rich and poor nations alike.



Professor John Lynch, Department of Epidemiology, School of Public Health, University of Michigan, USA Email:

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