Health inequalities and the welfare state: perspectives from social epidemiology

George A. Kaplan

Abstract


It might be assumed that welfare states that have done so much to reduce inequality of opportunity have also reduced inequality of health outcomes. While great advances have been seen in reducing the rates of many diseases in welfare states, disparities in health have not been eliminated. Is it the case that lowering risks overall will leave disparities that cannot be remediated, and that such efforts are at the point of diminishing returns? The evidence suggests that this is not true. Instead the lens of social epidemiology can be used to identify groups that are at unequal risk and to suggest strategies for reducing health inequalities through upstream, midstream, and downstream interventions. The evidence suggests that these interventions be targeted at low socioeconomic position, place-based limitations in opportunities and resources, stages of the life course and the accumulation of disadvantage across the life course, and the underlying health-related factors that are associated with the marginalization and exclusion of certain groups. In their commitment to the values of equity and social justice, welfare states have unique opportunities to demonstrate the extent to which health inequalities can be eliminated.

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