Why Justice Is Good for Our Health The Social Determinants of Health Inequalities

Abstract We have known for over 150 years that an individual’s chances of life and death are patterned according to social class: The more affluent and educated people are, the longer and healthier their lives. These patterns persist even when there is universal access to health care-a fact quite surprising to those who think financial access to medical services is the primary determinant of health status. In fact, recent cross national evidence suggests that the greater the degree of socioeconomic inequality that exists within a society, the steeper the gradientof health inequality. As a result, middle-income groups in a less-equal society will have worse health than comparable or even poorer groups in a society with greater equality. Of course, one cannot infer causation from correlation, but there are plausible hypotheses about pathways that link social inequalities to health. Even if more work remains to be done to clarify the exact mechanisms, it is not unreasonable to talk here about the social “determinants” of health.2