Health inequalities by class and race in the US: what can we learn from the patterns?

Throughout most of the world, the term “health inequalities” generally refers to differences in health by social class, unless specified otherwise. In the United States, however, the most comparable term, “health disparities”, has generally referred to differences in health by race or ethnic group. Historically, public health data in the U.S. have been reported by race and far less frequently by class, reflecting a deeply-rooted belief that we have an essentially classless society. That notion may seem preposterous to anyone familiar with the wide and widening economic inequalities within the US. Nevertheless, the belief that this is a classless society is pervasive. It reflects longand deeply-held beliefs in the U.S. as “the land of opportunity,” where hard work and ability almost always pay off, and, conversely, those who are unsuccessful must not have worked hard or been smart enough. Inadequate consideration of socioeconomic factors is a massive obstacle to understanding the role of non-medical influences on health. Also, it reinforces scientifically unfounded assumptions about the role of genetic differences in racial or ethnic disparities in health, a convenient justification for accepting racial disparities in health, wealth, and well-being as inevitable.