Inequality in Levels of Health in England and Wales, 1891-1971

Abstract

This paper has two purposes. First, it provides a theoretical perspective for understanding the interrelationships among increasing equality of rights and greater equality of distribution and utilization of resources. It argues that increasing complexity, efficaciousness, and costs of technology lead to greater centralization in the delivery of services, which in turn leads to more equality of rights and to greater equality in the distribution and utilization of resources. Second, it confronts the question of whether the expanding equality of rights and the more equal distribution and utilization of resources over several generations bring about equality of results. Focusing on the structure of the British medical delivery system during the period between 1891 and 1971, the study concludes that increasing equality of access, of distribution of resources, and of utilization of services has not brought about more equality in levels of health across social classes. Since the British National Health Service has the most egalitarian service of any highly industrial society, the conclusions of the paper suggest that societies which wish to equalize levels of health across social classes might be more concerned with equalizing income and educational attainment.