I’ve been working recently on the relevance of growing income and wealth inequality for the issues of concern to bioethics. Gopal Sreenivasan pointed out in the Hastings Center Report a few years ago that universal health coverage is no panacea for social inequality in health—for the tendency of the wealthy to live longer and in better health, and the poor to live shorter lives more burdened with health deficits. In fact, using data from the UK’s Black Report (based on the famous Whitehall Study of civil servants), he pointed out that social inequality in health has increased since the implementation of the NHS. While I argue against his policy proposal (that we should address the social determinants of health instead of universal health coverage; see here), I also discussed some of the deep trends that lie in the background of this surprising data. This discussion is a starting point for discussing the normative and political significance of social inequality in health.
The Black Report data is based on male occupational status (British inequality studies have long been plagued by the problem of how to measure the class identity of women). Newly analyzed data from the US tells a troubling story about the gendering of growing social inequality in health.
While the growing inequality in life expectancy for men arises because richer men are getting healthier faster than poorer men are, the growing social inequality in health for women is driven both by the increasing health of the wealthiest women—and by a drop in life expectancy of the poorest third of women. The poorest 10%, born in 1920, could expect to live to 78 or 79; born in 1950, they barely pass 75. The New York Times summarizes the data.
What is happening with women’s health in America? It’s time for feminist bioethics to engage with distributional issues in population health.
Some sources:
The briefest summary of Piketty and Saez’s work:
- Piketty, T. & Saez, E. (2014). Inequality in the Long Run. Science, 344, 838-843.
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Some feminist responses to Piketty:
- Reid, L., (2015). Piketty and the Body: On the Relevance of Wealth Inequality to Bioethics. IJFAB, 8, 250-265. http://bit.ly/1UT4oKU
- Anderson, Elizabeth. 2015 (Dec 7). The Politics Behind Piketty. Crooked Timber [blog]. http://crookedtimber.org/2015/12/07/the-politics-behind-piketty/
The fullest policy proposals based on Piketty’s work:
- Marmot, M., (2015). The Health Gap: The Challenge of An Unequal World, London: Bloomsbury Publishing.
- Atkinson, A., (2015). Inequality: What Can Be Done? Cambridge MA: Harvard University Press;
The ‘big picture’ in social inequality in health:
- Reid, L., (2015). Answering the Empirical Challenge to Arguments for Universal Health Coverage Based in Health Equity. Public Health Ethics, advance access. http://bit.ly/1NU33m2
- Reid, L., (2015). Does Population Health Have An Intrinsically Distributional Dimension? Public Health Ethics, advance access. http://bit.ly/1iRD7fK
- Santosa, A.; Wall, S.; Fottrell, E.; Högberg, U.; & Byass, P. (2014). The Development and Experience of Epidemiological Transition Theory Over Four Decades: A Systematic Review. Global Health Action, 7, 59-71.
- Sreenivasan, G., (2007). Health Care and Equality of Opportunity. Hastings Center Report, 37, 21-31.
