About this Journal Publication ethics Editorial Board Editorial Council Editorial Office For the Authors Contacts

News feeds

Journal in Databases


Google Scholar

Google Scholar

For authors' attention

Publication is free of charge

In aims to provide interconnection of publications in international scientific journals using Digital Object Identification - DOI, our editorial office incorporated the journal "Social aspects of population health" into international reference system CrossRef.

Since 2016 DOI will be assigned to all scientific articles published in our journal free of charge.

Also DOI will be assigned to all articles published in 2014 and 2015 free of charge as well
Main arrow Archive of previous Issues arrow 2 2017 (54) arrow SOCIO-ECONOMIC INEQUALITY IN HEALTH: TRENDS AND HYPOTHESES
Friday, 19 May 2017

DOI: 10.21045/2071-5021-2017-54-2-1

Kislitsyna O.A.
Institute of Economics of the Russian Academy of Sciences, Moscow

Contacts: Olga A. Kislitsyna, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Information about author:
Kislitsyna O.A., http://orcid.org/0000-0002-4144-237X
Acknowledgments.The study had no sponsorship.
Conflct of interests. The authors declare no conflict of interest.


Significance of the study. Despite the fact that over the last century the health of the European population has much improved, there is a significant socioeconomic inequality in health in all countries of the region. People with low education, low professional class, and low incomes tend to die younger, have a shorter life expectancy, and higher prevalence of various health problems. The socioeconomic inequality in health is unacceptable and unfair and represents one of the main public health challenges.

The purpose of the study was to highlight historical stages of researches in socioeconomic inequality in health, to present main trends and hypotheses that can explain those inequalities.

Methods. To fulfil this purpose, analysis of relevant domestic and foreign sources of literature was conducted. Literature search in eLIBRARY and PubMed derived studies that included terms related to health inequality and its state in Europe and/or socio-economic factors affecting health mentioned in article itself, title or abstract. 66 articles were selected for analysis and generalization out of a total of over 400 sources. The remaining articles were extracted from the analysis due to lack or incomplete information necessary for comprehending the study concept.

Results of the study. The socio-economic inequality in health in all countries of the European region over the past decades not only diminished, but also expanded, which is most noticeable in countries of the Eastern Europe. The literature makes it possible to formulate the following three main hypotheses that can explain the socioeconomic inequality in health. According to the first hypothesis, based on the theory of social selection, health determines socio-economic situation (and not vice versa) and, to a large extent, explains socioeconomic inequality in health. However, the most important is the hypothesis of social causality, according to which the socio-economic situation influences health through intermediate factors (material, psychosocial, behavioural, etc.).

According to the "life journey hypothesis", socio-economic inequality in health of the adult population is partially explained by various aspects of development at an early age.

Conclusions. This literature review confirms that socioeconomic factors have significant impact on health through various mechanisms. Therefore, overcoming social and economic health inequality requires involvement of many ministries and departments, in addition to healthcare, that cannot directly prevent mortality and ill health, but can affect the underlying causes.

: ; ; ; - .

Keywords: health; health disparities; health inequality; socio-economic factors.


  1. Vagero D., Kislitsyna O. Svyaz' mezhdu samootsenkoy serdechno-sosudistykh zabolevaniy i bednost'yu v Rossii [The link between self-assessment of cardiovascular diseases and poverty in Russia]. Narodonaselenie 2003; 21(3): 87-92. (In Russian).
  2. Ivanova A., Zemlyanova E., Mikhaylov A., Golovenkin S. Razlichiya v smertnosti vzroslogo naseleniya Rossii po urovnyu obrazovaniya [Differences in the death rate among the adult population of Russia in terms of education]. Zdravookhranenie Rossiyskoy Federatsii 2014; 58(2): 4-8. (In Russian).
  3. Kislitsyna O. Sotsial'no-ekonomicheskie determinanty zdorov'ya rossiyan [Socioeconomic determinants of health of Russians]. Narodonaselenie 2007; 36(2): 24-37. (In Russian).
  4. Kislitsyna O.A., Ferlander S. Rol' sotsial'nykh otnosheniy v ob"yasnenii sotsial'no-ekonomicheskikh razlichiy v sostoyanii zdorov'ya rossiyan [The role of social relations in explaining the socioeconomic differences in health of Russians]. Sotsial'nye aspekty zdorov'ya naseleniya [serial online] 2015 [cited 2017 Apr 20]; 44(4). Available from:http://vestnik.mednet.ru/content/view/694/30/lang,ru/. (In Russian).
  5. Kuz'mich O., Roshchin S. Vliyanie zdorov'ya na zarabotnuyu platu i zanyatost': empiricheskie otsenki otdachi ot zdorov'ya [Health effects on wages and employment: empirical assessments of health outcomes]. Preprint WP15/2007/02. Moscow: GU VShE. 2007. 60 p. (In Russian).
  6. Maksimova T.M. Sotsial'nyy gradient v formirovanii zdorov'ya naseleniya [Social gradient in the formation of public health]. Moscow: PER SE. 2005. 240 p. (In Russian).
  7. Shkol'nikov V., Andreev E., Maleva T., editors. Neravenstvo i smertnost' v Rossii. [Inequality and mortality in Russia]. Moskovskiy Tsentr Karnegi. Moscow: Signal'. 2000. 107 p. (In Russian).
  8. Aarts MJ, Hamelinck VC, Bastiaannet E, Coebergh JWW, Liefers GJ, Voogd AC, et al. Small but significant socioeconomic inequalities in axillary staging and treatment of breast cancer in the Netherlands. British journal of cancer 2012; 107(1): 12-17.
  9. Adler N, Boyce T, Chesney M, Cohen S, Folkman S, Kahn R, et al. Socioeconomic Status and Health: The Challenge of the Gradient. Am Psychol 1994; 49(1): 15-24.
  10. Artazcoz L, Cortès I, Escribà-Agüi V, Cascant L, Villegas R. Understanding the Relationship of Long Working Hours with Health Status and Health-related Behaviours. Journal of Epidemiology and Community Health 2009; 63(7): 521527.
  11. Barker DJ. Fetal origins of coronary heart disease. BMJ 1995; 311(6998):171-174.
  12. Bosma H, Schrijvers C, Mackenbach JP. Socioeconomic inequalities in mortality and importance of perceived control: cohort study. BMJ 1999; 319(7223): 14691470.
  13. Braveman P, Gottlieb L. The Social Determinants of Health: Its Time to Consider the Causes of the Causes. Public Health Reports 2014; 29(2): 1931.
  14. Burström K, Johannesson M, Diderichsen F. Increasing socio-economic inequalities in life expectancy and QALYs in Sweden 1980-1997. Health Econ. 2005 Aug; 14(8): 831-50.
  15. Carlson P. Educational differences in self-rated health during the Russian transition. Evidence from Taganrog 19931994. Soc Sci Med 2000; 51(9):13631374.
  16. Davey Smith G, Hart C, Watt G, Hole D, Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley study. J Epidemiol Community Health 1998; 52(6): 399-405.
  17. Dionne C, Von Korff M, Koepsell T, Deyo R, Barlow W, Checkoway H. Formal education and back pain: a review. J Epidemiol Community Health 2001; 55(7): 455-68.
  18. Droomers M, Schrijvers CTM, Mackenbach JP. Educational level and decreases in leisure time physical activity: predictors from the longitudinal GLOBE study. Journal of Epidemiology & Community Health 2001; 55(8): 562-568.
  19. Droomers M, Schrijvers CT, Mackenbach JP. Educational differences in the intention to stop smoking. European Journal of Public Health 2004; 14(2): 194-198.
  20. Dubikaytis T, Härkänen T, Regushevskaya E, Hemminki E, Haavio-Mannila E, Laanpere M, et al. Socioeconomic differences in self-rated health among women: a comparison of St. Petersburg to Estonia and Finland. International Journal for Equity in Health 2014; (13):39.
  21. Gorey K, Holowaty E, Fehringer G, Laukkanen E, Richter N, Meyer C. An international comparison of cancer survival: relatively poor areas of Toronto, Ontario and three US metropolitan areas. J Public Health Med 2000; 22(3): 343-8.
  22. Hart CL, Taylor MD, Davey Smith G, Whalley LJ, Starr JM, Hole DJ, Wilson V, Deary IJ. Childhood IQ, social class, deprivation, and their relationships with mortality and morbidity risk in later life: prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies. Psychosomatic Medicine 2003; 65(5): 877-883.
  23. Heistaro S, Laatikainen T, Vartiainen E, Puska P, Uutela A, Pokusaeva S, et al. Self-reported health in the republic of Karelia, Russia and in North Karelia, Finland in 1992. Eur J Public Health 2001; (11):7480.
  24. Isaacs S, Schroeder S. Class The Ignored Determinant of the Nations Health. N Engl J Med 2004; 351(11): 1137-42.
  25. Kahn R, Wise P, Kennedy B, Kawachi I. State income inequality, household income, and maternal mental and physical health: cross sectional national survey. BMJ 2000; 321(7272):1311-5.
  26. Kawachi I, Kennedy B, Glass R. Social capital and self-rated health: a contextual analysis. Am J Public Health 1999; 89(8): 1187-93.
  27. Kislitsyna O, Stickley A, Gilmore A, McKee M. The social determinants of adolescent smoking in Russia in 2004. International Journal of Public Health 2010; 55(6): 619-626.
  28. Kunst A, Bos V, Lahelma E, Bartley M, Lissau I, Regidor E, et al. Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 2005; 34(2): 295-305.
  29. Leinsalu M, Stirbu I, Vågerö D, Kalėdienė R, Kovács K, Wojtyniak B, et al. Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000. International Journal of Epidemiology 2009; 38(2): 512-525.
  30. Lemstra M, Mackenbach J, Neudorf C, Nannapaneni U. High health care utilization and costs associated with lower socio-economic status: results from a linked dataset. Canadian Journal of Public Health 2009; 100(3):180-3.
  31. Lindstrom M, Hanson B, Wirfalt E, Östergren P. Socioeconomic differences in the consumption of vegetables, fruit and fruit juices. The influence of psychosocial factors. Eur J Public Health 2001; 11(1): 51-9.
  32. Lundberg J, Bobak M, Malyutina S, Kristenson M, Pikhart H. Adverse health effect of low levels of perceived control in Swedish and Russian community samples. BMC Public Health 2007; 7(1):314.
  33. Lynch J, Davey Smith G, Kaplan G, House J. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ 2000; 320(7243):1200-4.
  34. Mackenbach JP. Unhealthy differences. About social stratification and health in The Netherlands. Assen: Van Gorcum. 1994.
  35. Mackenbach J, Kunst A, Cavelaars A, Groenhof F, Geurts J. Socio-economic inequalities in morbidity and mortality in western Europe. EU Working Group on Socioeconomic Inequalities in Health. Lancet 1997; 349 (9066): 1655-9.
  36. Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, et al. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol 2003; 32(5): 830-7.
  37. Mackenbach J. Genetics and health inequalities: hypotheses and controversies. J Epidemiol Community Health 2005; 59(4): 268-73.
  38. Mackenbach JP. Health Inequalities: Europe in Profile. Department of Public Health. Erasmus MC University Medical Center. Rotterdam. 2006.
  39. Mackenbach JP. Can we reduce health inequalities? An analysis of the English strategy (19972010). Journal of Epidemiology and Community Health 2011; 65(7): 568-575.
  40. Manor O, Matthews S, Power C. Health selection: the role of inter- and intra-generational mobility on social inequalities in health. Soc Sci Med 2003; 57(11): 2217-27.
  41. Marmot M, Shipley M, Rose G. Inequalities in death specific explanations of a general pattern? Lancet 1984; 1(8384): 1003-6.
  42. Marmot M, Davey Smith G, Stansfeld S, Patel C, North F, Head J, et al. Health inequalities among British civil servants: the Whitehall II study. Lancet 1991; 337(8754): 1387-93.
  43. Marmot M. Tackling health inequalities since the Acheson Inquiry. J Epidemiol Community Health 2004; (58): 262-3.
  44. Nicholson A, Bobak M, Murphy M, Rose R, Marmot M. Socio-economic influences on self-rated health in Russian men and women - a life course approach. Soc Sci Med 2005; 61(11): 23452354.
  45. Palosuo H, Uutela A, Zhuravleva I, Lakomova N. Social patterning of ill health in Helsinki and Moscow. Results from a comparative survey in 1991. Soc Sci Med 1998; 46(9):11211136.
  46. Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med 1993; 329(2): 103-9.
  47. Patterson C, Dahlquist G, Soltesz G, Green A. Is childhood-onset type I diabetes a wealth-related disease? Ecological analysis of European incidence rates. Diabetologia 2001; 44(3): 9-16.
  48. Plug I, Hoffmann R, Artnik B, Bopp M, Borrell C, Costa G, et al. Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care? BMC Public Health 2012; (12): 346.
  49. Power C, Graham H, Due P, Hallqvist J, Joung I, Kuh D, et al. The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison. International Journal of Epidemiology 2005; 34(2): 335-344.
  50. Power C, Matthews S. Origins of health inequalities in a national population sample. The Lancet 1997; 350(9091): 1584-1589.
  51. Shkolnikov V M, Andreev E M, Jasilionis D, Leinsalu M, Antonova O. I, McKee M. The changing relation between education and life expectancy in central and eastern Europe in the 1990s.Journal of Epidemiology and Community Health 2006; 60(10): 875-881.
  52. Shkolnikov VM, Andreev EM, Jdanov DA, Jasilionis D, Kravdal Ø, Vågerö D, et al. Increasing absolute mortality disparities by education in Finland, Norway and Sweden, 19712000. Journal of Epidemiology and Community Health 2012; 66(4): 372-378.
  53. Siegrist J, Marmot M. Health inequalities and psychosocial environment - two scientific challenges. Soc Sci Med 2004; (58):1463-73.
  54. Singh-Manoux A, Ferrie J, Lynch J, Marmot M. The Role of Cognitive Ability (Intelligence) in Explaining the Association between Socioeconomic Position and Health: Evidence from the Whitehall II Prospective Cohort Study. Am J Epidemiol 2005; 161(9): 831-39.
  55. Stafford M, Marmot M. Neighbourhood deprivation and health: does it affect us all equally? Int J Epidemiol 2003; 32(3): 357-66.
  56. Steptoe A. Psychobiological processes linking socio-economic position with health. In: Siegrist J. and M. Marmot. editors. Social Inequalities in Health: New Explanations and Their Policy Implications. Oxford: Oxford University Press; 2006.
  57. Stirbu I, Kunst AE, Bopp M, Leinsalu M, Regidor E, Esnaola S, et al. Educational inequalities in avoidable mortality in Europe. Journal of Epidemiology and Community Health 2010; 64(10): 913-920.
  58. Strand B. H., Grøholt EK, Steingrímsdóttir ÓA, Blakely T, Graff-Iversen S, Næss Ø. Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960-2000. BMJ 2010; (340): c654.
  59. Stransfeld SA. Social support and social cohesion. In: Social Determinants of Health. Second edition. Marmot M. and Wilkinson RG, editors. Oxford: Oxford University Press; 2006.
  60. Subramanian S, Kim D, Kawachi I. Social trust and self-related health in US communities: A multilevel analysis. J Urban Health 2002; 79(1): 521-34.
  61. Sundquist K, Malmström M, Johansson SE. Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. J Epidemiol Community Health 2004; 58(1): 71-7.
  62. Townsend P, Davidson N. Inequalities in health: the Black Report. Harmondsworth: Penguin. 1982.
  63. Turrell G, Mathers C. Socio-economic inequalities in all-cause and specific-cause mortality in Australia: 1985-1987 and 1995-1997. Int J Epidemiol 2001; 30(2): 231-9.
  64. Vanobbergen J, Martens L, Lesaffre E, Declerck D. Parental occupational status related to dental caries experience in 7-year-old children in Flanders (Belgium). Community Dent Health 2001; 18(4): 256-62.
  65. WHO. Systematic review of the link between tobacco and poverty. Geneva, Switzerland: World Health Organization, Institute for Clinical Effectiveness and Health Policy. 2011.
  66. Wilkinson RG, Pickett KE. Income inequality and population health: A review and explanation of the evidence. Social Science & Medicine 2006; 62(7): 17681784.

Views: 6671

Be first to comment this article

Write Comment
  • Please keep the topic of messages relevant to the subject of the article.
  • Personal verbal attacks will be deleted.
  • Please don't use comments to plug your web site. Such material will be removed.
  • Just ensure to *Refresh* your browser for a new security code to be displayed prior to clicking on the 'Send' button.
  • Keep in mind that the above process only applies if you simply entered the wrong security code.

Code:* Code

Last Updated ( Friday, 09 June 2017 )
Next >
home contact search contact search