Contextual variations in the meaning of health inequality

The meaning of inequality in health is contextually determined; it changes both within and between countries and over time. This paper points to the limited ability of the classic class-based analyses of inequalities in health to explain such change. An alternative form of analysis, based on the interaction between age, gender and cause of death is proposed. Within this framework, intercountry (European) comparisons of life expectancy and age-specific mortality for both sexes are used to illustrate a shift over time in the social aetiology of disease from economic to behaviourally based causality. Implications for the British experience and for British social policy are discussed.