查看文章

The importance of socioeconomic conditions for health has been recognized for centuries (1–3). No matter whether we are talking about the mill towns of Victorian England (4), the sweatshops of New York in the Gilded Age (5), or the slums of Mumbai in contemporary India (6), the poor in every society tend to have worse health and shorter lives than the wealthy. Even comparing societies and time periods in which the leading causes of death are completely different, the socioeconomic pattern in early mortality is almost always the same: the poor die first. Socioeconomic inequalities1 in health are apparent at almost every stage in the lifecourse, from birth (neonatal outcomes, infant mortality) to working age (eg, cardiovascular disease, accidents) and old age (functional disability). Lower socioeconomic status (SES) is correlated with increased risks of nearly every major cause of premature mortality (7). Moreover, socioeconomic inequalities in health status are not just a threshold effect of poverty; there is a “gradient” in health across the SES hierarchy such that the higher the level of household income, wealth, education, or occupational ranking, the lower the risks of morbidity and mortality. The gradient of health is observed almost throughout the range of socioeconomic status, so that the middle class have better health than the poor, and the wealthy have better health than the middle class (2). Socioeconomic status is typically characterized along three dimensions: education, employment, and money. Major health inequalities prevail along all three dimensions. The lower an individual’s position in the occupational hierarchy of a workplace, the …