Philosophical investigations of socioeconomic health inequalities

Abstract

Socioeconomic health inequalities as a political concernAlthough only in the last decennia problematised as a matter of 'health inequity', the correlation between health and occupation, income and/or education levels, is known to exist since ages. Before governments existed, Chapter 1 12 However, in 2003, the Dutch government was criticised by the Netherlands Court of Audit for taking insufficient action regarding socioeconomic health inequalities (Tweede Kamer 2003). In response, the Dutch government repeated its ambition to reduce avoidable socioeconomic health disparities by raising the life expectancy of the lower socioeconomic groups with three years (Ministry of Health, Welfare and Sports 2003). Nevertheless, health inequalities received hardly or no attention by the governments that followed. This silence was broken by Parliamentary questions in 2008, in response to which the Minister of Health presented an elaborate policy strategy to reduce socioeconomic health inequalities both improving structural factors, such as neighbourhoods and social participation, and stimulating healthy lifestyles.The proposals to address socioeconomic health disparities were explicitly motivated by a concern for 'social justice' (Ministry of Health, Welfare and Sports 2008). Despite these ambitious plans on paper, their effects appeared to be minimal (Broeders et al. 2018). Life expectancy overall has increased, but inequalities in health have persisted. It is in the light of their persistence that we can understand the recommendation of the Netherlands Scientific Council for Government Policy (WRR) to shift the focus in public health policies from aiming to reduce health inequalities to trying to utilise the health 'potential' of the whole population (Broeders et al. 2018). Inspired by Michael Marmot's 'proportionate universalism' -the idea that public health measures should address the entire population but in proportion to the degree of the health needs of specific groups (e.g. Marmot et al. 2010), the WRR argues to give extra attention to lower socioeconomic groups.In the year 2018, the Dutch Minister of Health, Welfare and Sports announced the 'Nationaal Preventieakkoord'. At the time of writing this introduction, it is unclear yet to what extent addressing socioeconomic health inequalities will be a central policy aspiration. Epidemiological attention to socioeconomic health inequalitiesSocioeconomic inequalities in health are often believed to have emerged after the ending of the great epidemics, in 17 th and 18 th century Europe, at a time when improvements were made in terms of nutrition, housing and private and public hygiene. That is, improvements in factors that were unequally This agreement comes with a shift from talking about poverty to talking about relative socioeconomic position. In this regard, the Whitehall Studies -started at the end of the 1960s in the UK -played an important role. By recording mortality and causes of death of about 17500 civil servants working at the London Whitehouse, a 'social gradie...

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