Sun, Jun 23, 2013 - Page 9 News List

Only the poor die young

While a partial failure of the welfare state may help to explain the persistence of health inequalities, one must look elsewhere to understand — and reverse — their rise

By Johan Mackenbach

Significant disparities in smoking, physical exercise, diet and alcohol consumption afflict many of Western Europe’s welfare states. The welfare system, which was created to combat poverty, has been less effective against “diseases of affluence” like heart disease and lung cancer.

All of this highlights the need for creative solutions to disparities that unnecessarily and unfairly blight the lives of those who have the least, create massive healthcare costs and pose a barrier to increased labor-force participation (impeding efforts in some countries to raise the retirement age).

In the past few decades, social policy in most Western European countries has moved away from redistribution. This is a mistake, given that the consequences of this shift — rising income inequality, weaker social safety nets and reduced healthcare access — will aggravate health inequalities in the long run.

In fact, more, better-targeted redistributive policies, which account for the effects of selective upward social mobility and different rates of diffusion of behavioral change, are crucial to improving health outcomes in lower socioeconomic groups. Income support should be complemented by preventive health programs, while health literacy programs could help to diminish the link between low cognitive ability and bad health.

Equal access to healthcare is not enough. Reducing inequalities in health outcomes requires more intensive healthcare for patients in lower socioeconomic brackets, tailored to their specific needs and challenges.

For example, revenues from tobacco taxation, which disproportionately affects lower income groups, should be used to fund cessation-support programs that target disadvantaged smokers.

Significant and persistent health inequality indicates that by raising the health levels of those with lower incomes or less education, massive strides could be made in improving populations’ overall health. This may require reshaping the welfare system to some extent, but the payoff would be well worth the effort.

Johan Mackenbach is a professor of public health and chair of the department of public health at Erasmus MC, University Medical Center Rotterdam and a member of the Royal Netherlands Academy of Arts and Sciences.

Copyright: Project Syndicate

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