A broader picture

Chapter 5 (‘A broader picture’) first discusses why not only health inequalities, but also social inequality is so persistent. After reviewing sociological theories from both the ‘functionalist’ and ‘conflict’ traditions, it chooses a middle road which acknowledges the ineradicable nature of social inequality. It then describes recent trends in welfare state reform, and identifies several areas, such as pensions and active labour market policies, where more attention to health inequalities is required. It also evaluates the common intuition that health inequalities are ‘unjust’, by applying five theories of justice (‘equality of welfare’, ‘capabilities approach’, ‘luck egalitarianism’, ‘justice as fairness’, and ‘equality of opportunity’). It concludes that, although health inequalities are not simply a form of social injustice, there are several compelling reasons to reduce health inequalities, including avoiding accumulation of disadvantage, solidarity with the less well-off, and reducing costs to society.