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Health inequalities and the welfare state: perspectives from social epidemiology


It might be assumed that welfare states that have done so much to reduce inequality of opportunity have
also reduced inequality of health outcomes. While great advances have been seen in reducing the rates of many diseases in welfare states, disparities in health have not been eliminated. Is it the case that lowering risks overall will leave disparities that cannot be remediated, and that such efforts are at the point of diminishing returns? The evidence suggests that this is not true. Instead the lens of social epidemiology can be used to identify groups that are at unequal risk and to suggest strategies for reducing health inequalities through upstream, midstream, and downstream interventions. The evidence suggests that these interventions be targeted at low socioeconomic position, place-based limitations in opportunities and resources, stages of the life course and the accumulation of disadvantage across the life course, and the underlying health-related factors that are associated with the marginalization and exclusion of certain groups. In their commitment to the values of equity and social justice, welfare states have unique opportunities to demonstrate the extent to which health inequalities can be eliminated.

Primary Toolkit:

Health Equity and Social Justice Toolkit

Keyword Area:

Best Practice, Health Equity


Institutional Author:

George A. Kaplan, University of Michigan





The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.