Class and Health

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Social Medicine had its birth during the Industrial Revolution in Europe as health statistics (a relatively new tool) made clear that disease and death were linked to poverty and exploitation.

One of the first empiric studies examining this question was done in the 1820’s by the French physician Louis Rene Villerme. Villerme looked at mortality statistics in Paris and noted marked differences in death rates between one section of the city and another. After considering several possible explanations, he concluded that poverty was the main determinant of differentials in death rates. We are fortunate that his original publication from 1830 is available online at the French National Library. We have discussed Villerme’s paper in greater detail in an article entitled “Social Medicine 101.”

Twenty years later Friederich Engel’s impassioned The Condition of the Working Class in England, described in detail the devastating health impact of the Industrial Revolution on workers and their families.

Two centuries later these problems are very much with us. As Vicente Navarro pointed out in a 2004 Monthly Review article entitled “Inequality is Unhealthy“, a member of the corporate class in Europe lives some 7 years longer than an unskilled worker who is chronically unemployed; in the US, the gap is 14 years.

The debate over health inequalities in the English-speaking world was revitalized by Sir Douglas Black’s 1980 report on inequalities and health (most of which is available on the website of the Socialist Health Association). The Black Report is a very rich document born out of the flowering of Social Medicine in England after World War II. Later Allison Quick and Richard Wilkinson introduced the idea that mortality depends upon the degree of inequality in a society, irrespective of the absolute wealth of the country.

In the United States we are told there is no social class and the Federal government does not routinely collect statistics on class and health. Class issues are often discussed in racial terms or in terms of “inequality”. provides an introduction from a US perspective. The New York City-based Russell Sage Foundation has published a number of interesting social critiques, which are available on their website. There are several papers on the topic of inequality and health. See The Social Dimensions of Inequality, a literature review of the Foundation.

Matt Anderson

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