Socio-economic Position and Health

Abstract

Although most people would agree that lower socio-economic position (SEP) is associated with poorer health, there remain key debates over the measurement SEP, the mechanisms that explain this association with health, and the policy responses to such inequalities in health. The WHO Commission on the Social Determinants of Health addressed many of these issues. Measures of SEP should ideally reflect the mechanism generating social inequalities and not just simply describe stratification. Furthermore, different measures of SEP reflect different dimensions of SEP. So most epidemiological studies that claim to “adjust” for SEP by using a single crude measure of SEP are inaccurate. Explanations of the association of SEP with health are multi-factorial as they are about people’s living, working and growing conditions. Debates over the primacy of one factor over another ignore the reality that these risk factors accumulate in lower SEP individuals and groups across the life course. Policies to address social inequalities in health need to address the whole of the social gradient, not just target the extreme poor and disadvantaged. Targeted health sector interventions to the poorest groups alone will not reduce health inequalities. Coordinated inter-sectoral action that affects the living, working and growing conditions across all of society is needed.