Health Inequality: An Introduction to Theories, Concepts and Methods. Mel Bartley. Cambridge: Polity Press, 2004, pp. 224, £16.99 (PB), ISBN: 0745627803

Abstract

This book is written by one of the key researchers, who is an intellectual force, in the field of health inequalities. A professor of Medical Sociology at University College London, Mel Bartley has played a distinguished role in this field for a number of years; this book further adds to his contribution.The book opens appropriately with a chapter on ‘What is health inequality?’ This has become a ubiquitous term not only in research but also in health and social policy in recent (‘New Labour’) years, but must not go unchallenged. In the UK, the Black Report of 1980 is noted as the definitive report that put health inequalities on the academic and policy agenda of industrialized nations. In that context ‘health inequalities’ refers to ill health and mortality being related to social class but also more generally to the ‘health differences between people in more or less favourable situations with respect to income, prestige (“standing in the community”) and education’ (p. 1). In this first chapter, as the patterns, magnitude, and changes in health inequality over the twentieth century are explained, so too are key terms and measures (such as standardized mortality rates and age-specific rates), a logical style that will particularly appeal to students. The key examples hail from the UK (this tends to be the case throughout the book although references to USA and to European studies are plentiful). A lot of ground is covered in this first chapter; theoretical explanations for health inequalities are introduced next: genetics (shown to be a non-starter for explaining health inequalities and therefore not covered in depth); the psycho-social model (e.g. control over work); direct and indirect selection; life-course models (which among other things can be used to test theories of indirect selection); and the neo-materialist explanation (emphasizing the importance, for example, of the provision of health and other public services and welfare benefits, as well as the role of low incomes). These various theoretical explanations are finally classified into four types: material, cultural–behavioural, psycho-social and life course; Bartley is quick to point out that these do not have to be mutually exclusive.