An Economic Framework for Analysing the Social Determinants of Health and Health Inequalities

Background CHE Discussion Papers (DPs) began publication in 1983 as a means of making current research material more widely available to health economists and other potential users. So as to speed up the dissemination process, papers were originally published by CHE and distributed by post to a worldwide readership. The new CHE Research Paper series takes over that function and provides access to current research output via web-based publication, although hard copy will continue to be available (but subject to charge). Disclaimer Papers published in the CHE Research Paper (RP) series are intended as a contribution to current research. Work and ideas reported in RPs may not always represent the final position and as such may sometimes need to be treated as work in progress. The material and views expressed in RPs are solely those of the authors and should not be interpreted as representing the collective views of CHE research staff or their research funders. Access to downloaded material is provided on the understanding that it is intended for personal use. Copies of downloaded papers may be distributed to third-parties subject to the proviso that the CHE publication source is properly acknowledged and that such distribution is not subject to any payment. Printed copies are available on request at a charge of £5.00 per copy. Please contact the CHE Publications Office, email [email protected], telephone 01904 321458 for further details. Summary Reducing health inequalities is an important part of health policy in most countries. This paper discusses from an economic perspective how government policy can influence health inequalities, particularly focusing on the outcome of performance targets in England, and the role of sectors of the economy outside the health service – the 'social determinants' of health-in delivering these targets. There has been some theoretical work in economics on the interaction between income, personal behaviour, and health. The core of these models is an assumption that individuals pursue a number of objectives, not all related to longevity and health. Within these models, health is valued for its own sake, and also promotes pursuit of other objectives: work, raising family, and participating in the community. Personal choices may therefore be made perfectly rationally to maximize these objectives, but may not necessarily maximize health. Furthermore, these models offer no unambiguous predictions about the relationship between the social gradient and health behaviour or health. However, if income has an increasing influence on health as …