Divided we fall

The poor pay the price of increased social inequality with their health

In Britain, as in many other countries, the scale of the excess mortality associated with lower social status dwarfs almost every other health problem. The Whitehall study hasshown that the most junior office staff have three times the all cause mortality and six times the sickness absence rates of the most senior staff working in the same government offices.1 2 In this week's journal Phillimore and colleagues report that mortality in those aged 0-64 years is four times higher in the poorest than in the most affluent electoral wards of the Northern region of England. As an indicator of the effect of socioeconomic factors on the demand for services, over three quarters of the regional variation in the number of prescriptions provided per head of population is associated with differences in regional levels of unemployment.3

If risks as great as these resulted from exposure to toxic materials then offices would be closed down and populations evacuated from contaminated areas. The research reported by Phillimore and colleagues suggests that the more deprived sections of the population have paid a heavy price for the official failure to take the social causes of disease seriously. Although the …