People in lower socia-economic positions are generally worse off with respect to their health than people in higher positions. These so-called socia-economic inequalities in health exist from birth to death, in youth, adulthood and in old age. Socia-economic inequalities in health in adult life have been found in many European countries over a long period of time\\,2. The question on the processes that underlie the generation of these inequalities is still largely unanswered. The influential Black Report, which was published in Great Britain in 19823, offers some explanations for these inequalities. In this report the causal explanation and the selection mechanism are the most important mechanisms. The causal explanation implies that socia-economic health inequalities are caused by the unequal distribution across socia-economic groups of lifestyle f.1.ctors, material factors or psycho-social factors. The health selection mechanism involves that health affects social mobility: healthy people may move up whereas unhealthy people may move down in the social hierarchy. The latter hypothesis is also referred to as the 'drift hypothesis'3. The Black Report stresses the importance of the causation mechanism as an explanation for socio-econOlnic inequalities in health. Although behavioural factors are said to playa role in this mechanism, the role of material factors is suggested to be greater. In the Black Report little attention has been paid to childhood conditions.

health care, socio-economic inequality
J.P. Mackenbach (Johan)
Erasmus University Rotterdam
Prevention Fund
Erasmus MC: University Medical Center Rotterdam

van de Mheen, H. (1998, June 17). Inequalities in Health, to Be Continued? A life-course perspective on socio-economic inequalities in health. Erasmus University Rotterdam. Retrieved from