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Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG7 2UH, UK
b
Department of Health Sciences, University of York, UK
Available online 5 July 2007
Abstract
In this paper, we present evidence which suggests that key processes of social status differentiation, affecting health and
numerous other social outcomes, take place at the societal level. Understanding them seems likely to involve analyses and
comparisons of whole societies.
Using income inequality as an indicator and determinant of the scale of socioeconomic stratication in a society, we
show that many problems associated with relative deprivation are more prevalent in more unequal societies. We summarise
previously published evidence suggesting that this may be true of morbidity and mortality, obesity, teenage birth rates,
mental illness, homicide, low trust, low social capital, hostility, and racism. To these we add new analyses which suggest
that this is also true of poor educational performance among school children, the proportion of the population imprisoned,
drug overdose mortality and low social mobility.
That ill health and a wide range of other social problems associated with social status within societies are also more common
in more unequal societies, may imply that income inequality is central to the creation of the apparently deep-seated social
problems associated with poverty, relative deprivation or low social status. We suggest that the degree of material inequality in a
society may not only be central to the social forces involved in national patterns of social stratication, but also that many of the
problems related to low social status may be amenable to changes in income distribution.
If the prevalence of these problems varies so much from society to society according to differences in income
distribution, it suggests that the familiar social gradients in health and other outcomes are unlikely to result from social
mobility sorting people merely by prior characteristics. Instead, the picture suggests that their frequency in a population is
affected by the scale of social stratication that differs substantially from one society to another.
r 2007 Elsevier Ltd. All rights reserved.
Keywords: Income inequality; Socioeconomic status; Health; Education; Relative deprivation; Prisons
Introduction
A typical approach to examining contextual area
effects on health is to start by controlling out the
Corresponding author.
compositional effects of the socioeconomic characteristics of the population in those areas (DiezRoux, 1998; Merlo, 2003; Pickett & Pearl, 2001).
Because individual characteristics usually have the
most powerful inuence on the local health prole,
researchers adjust for them in order to see whether
there are residual positive or negative health effects
associated with features of the area itself.
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Fig. 1. Prevalence in mental illness in relation to income inequality among rich countries.
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Fig. 4. Imprisonment in relation to income inequality among the 50 US states and DC, also indicating states with and without the death
penalty.
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Fig. 5. Intergenerational social mobility in relation to income inequality among rich countries.
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