Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities

Soc Sci Med. 2004 Jan;58(1):41-56. doi: 10.1016/s0277-9536(03)00159-x.


This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. It is argued that global and national socio-political-economic trends have increased the power of business classes and lowered that of working classes. The neo-liberal policies accompanying these trends led to increased income inequality but also poverty and unequal access to many other health-relevant resources. But international pressures towards neo-liberal doctrines and policies are differentially resisted by various nations because of historically embedded variation in class and institutional structures. Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to "go beyond" the income inequality hypothesis towards consideration of a broader set of the social determinants of health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Developed Countries / economics
  • Global Health
  • Health Status Indicators*
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Middle Aged
  • Political Systems
  • Politics*
  • Poverty*
  • Social Class*
  • Social Justice*
  • Socioeconomic Factors
  • Sociology, Medical