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Published online by Cambridge University Press: 08 January 2025
As the WHO definition in the Introduction made clear, the concept of ‘social determinants of health’ covers a complex and politically challenging range of phenomena. In this chapter I first document the extent of present health inequalities in this country before discussing how these have changed over time and appraising rival explanatory theories. The emphasis will then switch to professional and policy sociologists’ culpable neglect of social structure in general and class relations in particular.
Health inequalities have been defined and measured in various ways, for example in terms of life expectancy, healthy life expectancy, long- term health conditions, access to formal care via the health care system, the quality of care received, behavioural risks to health, or wider factors such as income or housing. Consider first, life expectancy. This is closely related to people's socio- economic circumstances. The Index of Multiple Deprivation, which is based on factors like people's levels of income, employment, education and local levels of crime, is sometimes used to summarise the extent of people's deprivation within an area. In England, there is a strong relationship between deprivation and life expectancy. In 2017–19 women living in the least deprived 10 per cent of areas could, at birth, expect to live to 86.4 years, whereas women in the most deprived areas could expect to live to 78.7 years, a gap in life expectancy of almost eight years. For men, this gap was even wider, with a difference of 9.4 years between the life expectancy for those in the least deprived 10 per cent of areas (83.5 years) and the most deprived 10 per cent of areas (74.1 years). For any given level of deprivation, life expectancy in the north of England is lower than in the south of England. These inequalities have widened in recent years (King's Fund, 2022).
The King's Fund also comments on healthy life expectancy. In 2017– 19, people living in the least deprived areas could expect to live almost two decades longer in good health than those in the most deprived areas. People in the most deprived areas spend approximately a third of their lives in poor health, twice the proportion spent by those in the least deprived areas.
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