Commentary: Persistent Social Inequalities in Health—Insensitive Outcomes, Inadequate Policies, or Both?

Abstract

’s December 2011 issue (Frank and Haw2011), McCartney and colleagues (2013) raise six issues on whichwe would like to comment.First,theychallengeourmaincriticismoftheroutinelycollectedpop-ulationhealthoutcomesthatrecentannualScottishreportshaveusedtomonitorhealthinequalitiesbysocioeconomicstatus(SES)—namely,thatmanyoftheseelevenoutcomesareinherentlyunresponsive(oronlyveryslowly responsive) to policy or program interventions that can feasiblybe delivered by public-sector authorities. Specifically, McCartney andcolleagues disagree with our contention that the epidemiological insen-sitivity of many routinely collected health indicators to prompt changeis one of the reasons that Scotland and other jurisdictions (Mackenbach2012; Marmot et al. 2012) are currently finding health inequalities bysocial class very hard to reduce, at least in terms of the “absolute differ-ence” between the most and the least privileged socioeconomic groups’measures of health status. McCartney and colleagues imply that we aretooreadilylettingthegovernmentsofthesejurisdictions“offthehook,”in that these national policy documents have tended to commit repeat-edly to reducing such inequalities. They go on to suggest that thesegovernmentshavenotadequatelyaddressedthestructuralandeconomicpolicy–related determinants of social stratification per se. They then of-fer examples of recent situations around the world demonstrating thatdeliberate, redistributive government policies, combined with global