Socio-Economic Health Inequalities: Ever-Lasting Facts or Amenable to Change?

In this issue of the journal, Moradi et al., have demonstrated that in Kurdistan Province of Iran individuals in lower socio-economic groups are more likely to have several risk factors for non-communicable diseases, including insufficient consumption of fruit and vegetables, insufficient consumption of fish, high consumption of unhealthy fat and oils, and hypertension. Moradi et al.’s study was limited to a certain period of time (2005-2009) and to a certain location (Kurdistan Province of Iran). As such, the specific findings of the study, e.g. lower consumption of fruit and vegetables by the lower socio-economic groups, may be limited to this area and this time period. Nevertheless, the more general finding of this study – that the less advantaged people of the society are more exposed to causes of most diseases – are ubiquitous and have been documented ever since they were first studied. In 1830, Villermé’s studies in France showed that mortality was directly linked to poverty, a finding that was corroborated in a more recent re-analysis of the original data [2] . Likewise, in 1842, Edwin Chadwick showed that poor living conditions increased risk of disease and reduced life expectancy in England, [3] a finding that was partly responsible for the Public Health Act of 1848. The rich-poor health gradient still holds true in most parts of the world. For example, in the City of Glasgow, Scotland, where the National Health System provides universal services, the life expectancy in the most deprived neighborhoods is 12 years lower than that in the most affluent neighborhoods [4] . The differences are even more striking in the United States. In Baltimore City, for example, there is a 20-year gap across neighborhoods [5] .And one doesn’t have to be poor to suffer from adverse health consequences; other minor differences in social class can be consequential too. For example, a recent study of British civil servants, who are not poor, showed that those in the lowest socio-economic positions had a 60% higher risk of death compared to those in the highest socio-economic groups. [6]