Explaining health inequality: evidence from the UK.

0277-9536/$ e see front matter 2011 Elsevier Ltd. doi:10.1016/j.socscimed.2011.12.015 With its uniquely long historical series of officially collected data on occupational mortality, researchers in the UK have been well placed to investigate the causes of health inequality. Since 1921, the decennial Census of England and Wales has contained an “Occupational Mortality Supplement” that tabulates mortality according to groups of occupations, which came to be known as “social classes”. After 1931 the class groups were sufficiently comparable to allow trends to be discerned. The Black Report of 1980 (DHSS, 1980; Townsend, Davidson, & Whitehead, 1988), which put health inequality onto the agenda of research and policy for the next 30 years, was based on these official statistics. The official measure of social class used in the Report was not ideal as a measure of social inequality, as it was never clear exactly what it operationalized. In some census volumes it was described as a measure of ‘occupational skill’ and in others as ‘general standing in the community’. No attempts were ever made to validate either of these definitions. This may be one of the reasons why the official statistics, so influential in their description of health inequality, were less helpful when it came to understanding why it occurs. The Decennial Supplements on OccupationalMortality show the relentless increase of inequality in mortality, which if anything accelerated after the introduction of the UK’s National Health Service in 1946 and the implementation of the raft of policies known as the “Welfare State”. During this period, ‘full employment’ was an objective of government policy (for men only), as were the abolition of the other Five Great Evils of Squalor, Disease, Ignorance and Want. In pursuit of these aims, post war governments of both political colours built new housing and improved schooling as well as maintaining free health care and benefits for the unemployed.