The Social Hierarchy of Health

Quotes from an article on Social Hierarchy of Health.

The disease and suffering of disadvantaged people in all countries are a result of the way we organise our societies.

A physician faced with a suffering patient has an obligation to make things better. If a society is making people sick, we have a moral obligation to improve public health and to reduce health inequalities as a matter of social justice.

The social gradient in mortality is a broader issue than that of poverty and health. A study by Marmot of government workers in Whitehall, London, found that while everyone had access to clean water, sanitation, abundant food, and shelter, the risk of dying was related to where they stood in the social hierarchy. In England, the life expectancy gap between men living in rich and poor areas is 11 years and the gap is even bigger in the United States of America between whites and blacks in the same geographical region.

There is a clear relation between a country's affluence and the life expectancy of its population, up to a per capita income of about $5,000. Beyond this, factors like social environment have a greater influence. The excess mortality among the poor in a rich country like the USA is from non-communicable disease and violent deaths.

Power, then, is the key. Control, autonomy, and freedoms might sound like psychological properties of the individual. Power relations in society, as they operate through social institutions and the opportunities afforded to those in relatively disadvantaged positions, are the social causes of degrees of empowerment. Freedom does not imply privileging the rights of some individuals at the expense of the well-being of others. Human rights can be taken as implying an obligation on society to do what is necessary to bring about the important freedoms for everyone.