Given that all of these theories can, to some extent, be supported by scientific evidence, politics can matter more than science in determining which strategies policymakers pursue to reduce health inequalities. After all, some potential solutions are politically easier to implement within existing systems than others.
For example, interventions aimed at changing individual behavior are far less challenging to prevailing power structures than those that demand extensive social investment or revitalization of the entire system. Thus, governments interested in closing the health gap — such as the British Labour government from 1997 to 2010 — usually end up pursuing such relatively painless “downstream” interventions.
However, this approach has proved to be only partly successful in reducing health inequalities, leaving little doubt that more comprehensive measures are needed. Indeed, most of the health gains over the 19th and 20th centuries were brought about by far-reaching economic, political and social reforms.
Ultimately, more equal societies have better health outcomes. While even the most egalitarian developed countries have health inequalities, all of their citizens are better off and live longer. The poorest and most vulnerable groups in social-democratic countries like Sweden and Norway are far healthier and live longer than their counterparts in neo-liberal countries such as the UK or the US. These more egalitarian countries have also achieved comparatively stable, inclusive economic growth and a high standard of living. So, if assessed from a neutral standpoint, social democracy is clearly the better choice for all.
Clare Bambra is a professor of public health policy and director of the Wolfson Research Institute for Health and Wellbeing at Durham University in the UK.
Copyright: Project Syndicate