From:
Equity, Health & Human Development [mailto:[log in to unmask]] On Behalf Of Ruggiero, Mrs. Ana Lucia (WDC)
Subject: [EQ] Who owns health
inequalities?
Who owns health inequalities?
Constance A Nathanson, Mailman
The Lancet, Volume 375, Issue 9711, 23 January 2010
Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60119-5/fulltext
“…..Health inequalities are old news—very old
news. John Graunt's analysis of the English
Bills of Mortality, statistically documenting the fact of inequality
in death, was published in the mid-17th century. Beginning early in the 19th
century, death rates by occupation compiled by the Registrar General's Office
in
The facts of inequality
in disease and death were well known before the beginning of the 20th century.
Their perennial rediscovery in the years since has little to do with lack of
knowledge and much to do with heated (and value-laden) disagreement among
scholars, bureaucrats, and politicians about why inequalities exist, what
should be done about them, and who should do it…..”
“…..Are health “inequalities” a problem of
the poor (and thus soluble by changing poor people's circumstances or
behaviour) or are they an effect of rigid patterns of social stratification
(requiring that resources be redistributed)? Are they
“voluntary”—the result of bad choices (“booze and
fags”)—or “involuntary”—the consequence of
oppressive social structures? Should inequalities be framed as
“disparities”—mere differences that may or may not be the
result of human action—or as unacceptable “inequities”?
And finally, who “owns” health inequalities? Are they—as in
the 19th century—a public health problem or are they a medical care
problem? Are they a private problem or a public problem? These are not logical
or empirical questions. They are political questions. How they are answered
will depend on the policy preferences of those in power, or who aspire to
power. I illustrate these points with the examples of the
*
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