What causes social inequalities: Why is this question taboo?

Abstract

Social inequalities are a pre-eminent cause of preventable disease and disability. They constitute an intractable problem for public health practitioners who aim to promote health. The extent of social inequalities varies from one society to another suggesting that they are amenable to change. However, apparently simple solutions such as redistribution of income do not seem to be simple to achieve. Public health research has focused more on the impact of social inequalities than on their causes. Studies of interventions to mitigate this impact have tended to focus on methods of reducing the level of disease at the lower end of the income distribution. The application of public health theory, however, suggests that the causes of social inequalities are likely to lie as much with the attributes of high-income groups as with those of low-income groups. Conflict management and psychotherapeutic theory suggest that the development of emotional literacy amongst those in all income brackets, but particularly the wealthy, has the potential to solve the problem of social inequalities in health. Research and development into social inequalities in health would benefit from a wider focus, which considered the causes of this phenomenon, and from the development of preventive interventions that were effective at both ends of the income distribution.