Explaining Socioeconomic Inequalities in Health Behaviours: the role of environmental factors

Abstract

In general, those who are worse off in terms of power, knowledge and wealth are also worse off in terms of health. This inverse relation between socioeconomic status (ses ) and health has been observed for centuries . With few exceptions, the association exists regardless of the measure of ses that is employed (education, income, or occupation) or the health outcome studied. Still today, in a developed country like the Netherlands, considerable socioeconomic differences in health exist. Those with a lower socioeconomic position live three to five years shorter than their higher status counterparts (on average), and also spend ten to fifteen more years in poorer health. Lower socioeconomic groups have higher rates of morbidity and mortality from cardiovascular diseases, obesity, type 2 diabetes and cancers [, report more health problems and complaints, and have poorer self-perceived health. Despite all advances during the last century that have resulted in today’s modern society, health inequalities have not reduced over time, in fact, they have even widened over the recent decades. However, the common convention in nowadays’ Western societies is that socioeconomic health inequalities should be reduced, for several reasons. First, health inequalities are considered unjust, as the poorer health of lower socioeconomic groups is at least partly due to societal and environmental processes which are beyond their individual control. Secondly, good health and freedom of choice are valued high within our society, and good health is an important predisposition for every individual’s opportunities in life. Thirdly, if the average health status of lower ses groups could be upgraded to the level of their more advantaged counterparts, this would have large