Editorials

What would happen to health inequalities if smoking were eliminated?

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d3460 (Published 28 June 2011) Cite this as: BMJ 2011;342:d3460
  1. Johan P Mackenbach, professor of public health
  1. 1Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, Netherlands
  1. j.mackenbach{at}erasmusmc.nl

They would persist at a lower level because obesity would fill part of the gap

Socioeconomic inequalities in mortality are a stubborn phenomenon. During the 20th century, despite increases in prosperity and various policies to take the sharper edges off social inequality, the gap in survival between those with a lower and a higher socioeconomic position has not disappeared. On the contrary, many countries in western Europe and North America have seen a widening of this gap during the past 40 years.1

In many of these countries, smoking now is one of the most important mediators of the effect of low socioeconomic position on mortality. Among men, and in some countries among women, smoking has been declining for several decades. Because this decline has been most prominent in more highly educated people and those with higher incomes, smoking has become relatively more common in lower socioeconomic groups.2 3 The linked cohort study by Hart and colleagues (doi:10.1136/bmj.d3785) is a welcome opportunity to see what could happen to health inequalities if …

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