Elite class self-interest, socioeconomic inequality and U.S. population health.

Abstract

Class-based perspectives on the persistent social gradients in health within modern welfare states largely focus on the adverse consequences of unfettered neoliberalism and entrenched meritocratic socioeconomic selection. Namely, neoliberal-driven economic inequality has fuelled resentment and stress among lower-status groups, while these groups have become more homogeneous with regard to health behaviours and outcomes. We synthesise several sociological and historical literatures to argue that, in addition to these class-based explanations, socioeconomic inequality may contribute to persistent social gradients in health due to elite class self-interest-in particular elites' preferences for overdiagnosis, overprescription and costly high-technology medical treatments over disease prevention, and for increased tolerance for regulatory capture. We demonstrate that this self-interest provides parsimonious explanations for several contemporary trends in U.S. health inequality including (A) supply-side factors in drug-related deaths, (B) longitudinal trends in the social gradients of obesity and chronic disease mortality and (C) the immigrant health advantage. We conclude that sociological theories of elite class self-interest usefully complement theories of the psychosocial effects of neoliberalism and of meritocratic social selection while answering recent calls for research on the role advantaged groups play in generating inequalities in health, and for research that moves beyond technological determinism in health sociology.