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Health inequalities: lifecourse approaches
  1. Kathryn Backett-Milburn

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    Edited by George Davey Smith. Bristol: The Policy Press, 2003, pp 548. ISBN 1-86134-322-1

    This weighty and impressive collection describes and critically assesses the development of lifecourse approaches to understanding health inequalities over the past two decades. In part, these approaches reflect the revival of interest in early years’ influences on adult health and mortality. However, this book goes much further, showcasing several important studies that demonstrate how the social and the physical are mutually constitutive throughout the lifecourse and that trajectories and processes of influence vary with different illness conditions. Lifecourse approaches, made possible partly because of the development of longitudinal datasets, have resulted in a questioning of theories about how health inequalities develop and persist. Some of these papers show a simple cumulative lifecourse effect of exposure to health risks and insults; others examine critical time windows of exposure and influences of particular inheritances or life and lifestyle experiences. Frustations that, as products of their academic and political times, these datasets have inherent limitations, are evident in several papers. Nevertheless, this collection (39 papers, all co-authored by George Davey Smith) shows yet again that social structural factors are crucially important in generating health inequalities and includes many challenges to policy makers to tackle poverty. There are weaknesses. Although acknowledged by the editor, the gender blindness of much of this collection must still be seen as a deficit. Another is that explicit attention to culture, beliefs, and behaviour seems only to occur in the section on ethnic inequalities in health, (although the idiosyncratic “Diversions” section perhaps shows the editor’s inherent sociological talents!). However, by highlighting the part played by social and cultural processes and clearly discussing the exceptions to notions of straightforward linear causality or general susceptibility theory, this collection should convince even the sceptical of the heuristic benefits of taking a lifecourse approach, the photographs are good too.

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