Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities
Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities
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DOI：
10.1016/s0277-9536(03)00159-x
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发表时间：
2004-01-01
影响因子：
5.4
通讯作者：
Coburn, D
中科院分区：
文献类型：
--
作者：
Coburn, D
本文对健康不平等的收入不平等方法进行了描述和批判。然后，它通过关注收入不平等的原因而不仅仅是后果，提出了一种替代的基于阶级的模式。在这个模型中，收入不平等和健康之间的关系在更广泛的因果关系链中看起来是一个特例。有人认为，全球和国家的社会政治经济趋势增加了商业阶级的权力，降低了工人阶级的权力。伴随这些趋势而来的新自由主义政策导致收入不平等加剧，但也导致贫困和获得许多其他与健康有关的资源的机会不平等。但由于阶级和制度结构的历史差异，各国对新自由主义理论和政策的国际压力受到了不同程度的抵制。所提供的数据表明，新自由主义与更大的贫困和收入不平等以及国家内部更大的健康不平等有关。此外，拥有社会民主党形式的福利制度的国家(即那些不那么新自由主义的国家)的健康状况比那些更新自由主义的国家更好。论文最后讨论了需要采取哪些进一步的步骤来“超越”收入不平等假设，以考虑更广泛的健康社会决定因素。(C)2003爱思唯尔科学有限公司。保留所有权利。
This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. It is argued that global and national socio-political-economic trends have increased the power of business classes and lowered that of working classes. The neo-liberal policies accompanying these trends led to increased income inequality but also poverty and unequal access to many other health-relevant resources. But international pressures towards neo-liberal doctrines and policies are differentially resisted by various nations because of historically embedded variation in class and institutional structures. Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to 'go beyond' the income inequality hypothesis towards consideration of a broader set of the social determinants of health. (C) 2003 Elsevier Science Ltd. All rights reserved.