Commentary: social inequalities in health, social epidemiology and social value

The collection of eight papers presented in this volume add tothe impressive social epidemiology literature on inequalities inhealth. In these latest contributions a variety of data sets from arange of countries are analysed using rigorous epidemiologicalmethods. In each case, those in poorer social circumstances fareless well than those with better social circumstances, whetherone is concerned with outcomes such as overall or cause-specificmortality, or health risk factors such as cognitive function orbehavioural threats to health. These inequalities remain aftercontrolling for known risk factors such as smoking behaviour.Even among heavy smokers, those in better social circumstances seem to be in some way ‘protected’ against some of theconsequences experienced by heavy smokers in poorer socialcircumstances. Other studies have shown that social inequalitiesextend further to the association between known risk factorsand health,1,2 the uptake of interventions aimed at reducing riskfactors or improving health3,4 and the outcome of interventions.5,6Despite the pervasiveness of social inequalities at each stageof the production of health, illness and recovery in populations,the literature remains largely confined to the identification anddescription of the problem of social inequalities and provideslittle insight into solutions to the problem. In common with othercontributions, many of the papers in the current collectionconclude with calls for reductions in social inequalities in healthrisks and effective public policy, targeted at less prosperousgroups to achieve these reductions in inequalities. However nodirection is offered concerning what these interventions mightbe or how we might go about uncovering such interventions.The ‘black box’ of how to reduce social inequalities in healthremains relatively unexplored by social epidemiologists. Butwhose interests are served by further information that the poorcome off worst in many aspects of the production of health,illness and recovery in populations? What is the social value, asopposed to the scientific merit, of more ‘replications’ of thesocial inequalities research? How can the achievements of socialepidemiological research to date be used to contribute to identifying ways of reducing social inequalities in health?