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Sociology of Industrial Societies Health inequalities in industrial societies Week 1 HT08 Health inequalities in industrial societies Lecture plan: Industrialization, health and the demographic transition How are health inequalities related to absolute income ?

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health inequalities in industrial societies

Sociology of Industrial Societies

Health inequalities in industrial societies

Week 1 HT08

slide2

Health inequalities in industrial societies

Lecture plan:

Industrialization, health and the demographic transition

How are health inequalities related to absolute income?

Might health inequalities be more closely linked to relative income in industrial societies?

The relative income hypothesis on health: some challenges

Health inequalities in industrial societies

Week 1 HT08

slide3

Industrialization, health and the Demographic Transition

  • 1. Pre-industrialization
    • High death rate
    • High birth rate
    • Stable pop. size
  • 2. Industrialization
    • death rate
    • Stable(ish) birth rate
    • Rapid pop. growth
  • 3. Early industrialism
    • Still death rate
    • birth rate
    • Pop. growth slows
  • 4. Late industrialism
    • Death rate levels off
    • Birth rate levels off
    • Pop. size stabilizes

The Demographic Transition in England

Crude birth rate

Crude death rate

Source:Mateos-Planas (2000), p. 5

Health inequalities in industrial societies

Week 1 HT08

slide4

Industrialization, health and the Demographic Transition

  • Average life expectancy substantially higher in industrialized countries

Source: http://www.maps.com/ref_map.aspx?pid=12869

Health inequalities in industrial societies

Week 1 HT08

slide5

How are health inequalities related to absolute income?

  • At the individual level, higher income means higher life expectancy
  • At the country level, higher average income means higher life expectancy…
  • …but relationship strongly curvilinear...
  • …tailing off after about £25K GDPpc

Source: CIA World Factbook

Health inequalities in industrial societies

Week 1 HT08

slide6

How are health inequalities related to absolute income?

  • Focusing on the most industrialized countries…
  • …practically no association between average income and life expectancy
  • Undisputed that association holds at individual level
  • But suggestion that across affluent societies, something other than absolute income also at play

Life expectancy and gross national product per capita in the world's 25 richest countries

Source: Marmot and Wilkinson (2001)

Health inequalities in industrial societies

Week 1 HT08

slide7

Might health inequalities be linked to relative income in industrial societies?

  • In industrial societies, life expectancy found to be lower in countries with greater income inequality
  • Taken by many to imply that Norwegians , say, live longer than the British and Americans because they live in a more equitable and egalitarian society

Correlation between life expectancy and income inequality among industrialized countries

Source: De Vogli et al (2005)

See also Wilkinson (1996)

Health inequalities in industrial societies

Week 1 HT08

slide8

Might health inequalities be linked to relative income in industrial societies?

  • Similar relationship found at lower levels of aggregation (US states, Italian regions, Chicago neighbourhoods)
  • Similar relationship found in relation to other health-related outcomes (stillbirths, infant mortality, homicides, violent crimes)

Correlation between Life expectancy and income inequality across US states

Source: Kennedy et al (1996)

See also Kaplan et al (1996)

Health inequalities in industrial societies

Week 1 HT08

slide9

Might health inequalities be linked to relative income in industrial societies?

  • Relationship between relative income and life expectancy at aggregate levels corresponds to that at individual level
  • One of most famous examples, the Whitehall Studies by Michael Marmot, found significant associations between Civil Service grade and actual and perceived health, linked to both physiological and social-psychological risk factors

Source: Marmot et al (2003)

Health inequalities in industrial societies

Week 1 HT08

slide10

Health inequalities linked to relative income?

  • The relative income hypothesis (see Wilkinson 1990, 1992, 1997, 2001)
  • Absolute income Relative income
  • Adequate nutrition, shelter, etc. Relative deprivation
  • Physiological well-being Psychosocial well-being
  • Health and life expectancy
  • In prosperous, industrial societies, relative, not absolute, income is key

Health inequalities in industrial societies

Week 1 HT08

slide11

The relative income hypothesis on health: some challenges

  • Population-level association between income inequality and life expectancy may be at least partly a statistical artefact arising from their non-linear association at the individual level

Source: Rodgers 2002

See also Gravelle 1999

Health inequalities in industrial societies

Week 1 HT08

slide12

The relative income hypothesis on health: some challenges

  • Is mean income an appropriate measure of absolute income at the population level?
  • Might median or modal income be a better measure, particularly in highly unequal societies?
  • On a more theoretical level, possibility of ecological fallacy
  • Can we plausibly infer from aggregated data something about individual responses to income inequality?
  • Further possibility of spurious correlation
  • Might other causal factors actually be at play, such as access to health care?

Health inequalities in industrial societies

Week 1 HT08

slide13

Health inequalities in industrial societies

  • Summary
  • Industrialization undoubtedly linked to improved health at the individual and population levels
  • In societies at all stages of industrial development, absolute income impacts on health at the individual level
  • However, studies show practically no association at the population level between mean income and average life expectancy across the most industrialized societies
  • Instead, income inequality seems to have much more explanatory power
  • Yet serious challenges to interpretations of population-level associations as indicative of associations at the individual level

Health inequalities in industrial societies

Week 1 HT08