An assessment of the Black Report's explanations of health inequalities

Abstract

The Black Report identifies four types of possible explanation for social class di^erences in health, and judges one of these ('materialist') to be the most important. This paper seeks to support this assessment with additional evidence from the literatures of sociology and medicine. In the process it suggests questions which could usefully be the subject of future research.

Life-course approaches to inequalities in adult chronic disease risk

“…In the attention that the Black Report received after its release it was the recommendations on how to reduce inequalities in health that were the focus of most interest. Initially, the approach of the Black Committee to the explanation received little comment, although a review by Blane (1985) began to redress this neglect. Blane's (1985) review and later reviews (for example, see Davey Smith et al 1994) concluded that: the magnitude of health inequalities was probably underestimated (rather than overestimated) because of artefacts in data collection and analysis; unfavourable social circumstances led to adverse health outcomes (rather than poor health leading to less-favourable social locations); the origins of health inequalities could not be ascribed in any simple way to the unconstrained adoption of insalubrious lifestyle choices.…”

“…Initially, the approach of the Black Committee to the explanation received little comment, although a review by Blane (1985) began to redress this neglect. Blane's (1985) review and later reviews (for example, see Davey Smith et al 1994) concluded that: the magnitude of health inequalities was probably underestimated (rather than overestimated) because of artefacts in data collection and analysis; unfavourable social circumstances led to adverse health outcomes (rather than poor health leading to less-favourable social locations); the origins of health inequalities could not be ascribed in any simple way to the unconstrained adoption of insalubrious lifestyle choices. One paper (Davey Smith et al 1994) concluded that the clustering of advantage and disadvantage across the life course was key: A woman in a low-income household is more likely to Infant mortality in 1896 -1925 Fig.…”

Contingent employment, health and sickness absence

“…Health selection is a process in which healthy people are more likely to move up and unhealthy people to move down the social and occupational hierarchy (36). There is strong evidence on health-related selective mechanisms for labor force mobility -from employment to unemployment (37)(38)(39)(40)(41), from unemployment to re-employment (41,42), in educational achievement (43,44), and in occupational mobility (45).…”

Human ecology, statistical analysis, and the logic of valid correlations DOI:10.5007/2175-7984.2011v10n19p57

“…Ranking of colleges and universities show how little we may be able to infer from a diploma or certificate of studies. (Blane, 1985;Stronks et al, 1996). These facts are well publicized, but this category appears nevertheless to have general acceptance in epidemiological studies as a blank check.…”