Health inequalities: trends, progress, and policy

Abstract

Health inequalities, which have been well documented for decades, have more recently become policy targets in developed countries. This review describes time trends in health inequalities (by sex, race/ethnicity, and socioeconomic status), commitments to reduce health inequalities, and progress made to eliminate health inequalities in the United States, United Kingdom, and other OECD countries. Time-trend data in the United States indicate a narrowing of the gap between the best- and worst-off groups in some health indicators, such as life expectancy, but a widening of the gap in others, such as diabetes prevalence. Similarly, time-trend data in the United Kingdom indicate a narrowing of the gap between the best- and worst-off groups in some indicators, such as hypertension prevalence, whereas the gap between social classes has increased for life expectancy. More research and better methods are needed to measure precisely the relationships between stated policy goals and observed trends in health inequalities.

Figure 1

Differences by socioeconomic status (SES) in selected behavioral risk factors and metabolic conditions, comparing early to later years. Notes: Data reflect differences between low- and high-SES groups, defined by education strata in the United States and social class in England. For U.S. smoking prevalence, the early year is 1990 and the later year is 2009. For U.S. obesity, hypertension, and diabetes prevalence, the early year is 1988–1994 and later year is 2008. For all England indicators, the early year is 2001 and the later year is 2009.

Figure 2

Differences by race in selected behavioral risk factors and metabolic conditions, comparing early to later years. *, Smoking reflects difference in prevalence between white and black populations, indicating a higher prevalence among white compared with black populations. Notes: Data reflect differences between non-Hispanic black and white populations. For U.S. smoking prevalence, the early year is 1990 and the later year is 2009. For U.S. obesity, hypertension, and diabetes prevalence, the early year is 1988–1994 and the later year is 2008. For all England indicators, the early year is 2001 and the later year is 2009.

Figure 3

Differences by race and socioeconomic status (SES) in life expectancy at birth, comparing early to later years. Notes: U.K. data reflect differences between social class I and social class VII. For US data, the early year is 1980 and the later year is 2007. For the U.K. data, the early year is 1982 and the later year is 2006.