The explanation of a paradox? A commentary on Mackenbach with perspectives from research on financial credits and risk factor trends

摘要

The article by Mackenbach in Social Science & Medicine (2012) aims to explain the public health paradox of why health inequalities persist and, in some cases, widen in the modern welfare states of Western Europe. The author suggests, based on his review of nine theories of health inequalities, that the most useful theories to pursue with hypothesis testing as to why inequalities in health have not fallen (or indeed have widened) are: persisting inequalities in access to material and non-material resources; greater inter-generational social mobility and stronger health selection; and consumption behaviours increasingly determining disease patterns. As in a recent commentary, Mackenbach (2010) concludes that personal, psychosocial, and cultural determinants need to be tackled to reduce health inequalities in modern welfare states. We follow Mackenbach's call for scientific discussion and empirical testing of his hypotheses, by firstly discussing the theory that inequalities in health are due to persisting inequalities in access to material and non-material resources, drawing on perspectives from our current research focus on publicly funded financial credits (cash benefits and tax expenditures) and their impact on health. We then discuss the hypothesis that consumption behaviours increasingly determine disease patterns, drawing on our research on disease and risk factor trends.