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Are socio-economic groupings the most appropriate method for judging health equity between countries?
  1. Chris Dibben,
  2. Frank Popham
  1. School of Geography and Geosciences, University of St Andrews, St Andrews, UK
  1. Correspondence to Dr Chris Dibben, School of Geography and Geosciences, University of St Andrews, St Andrews KY16 9AL, UK; cjld{at}standrews.ac.uk

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In recent years, a number of major studies have suggested, paradoxically given their focus on equity, that the Nordic welfare states do not have the lowest (relative) socio-economic health inequity in Europe.1–3 We wish to argue that this could be an artefact of the method employed in such studies. In short, the composition of socio-economic groups within a country is itself a product of the welfare state type under investigation. This makes it very difficult to evaluate welfare states by studying socio-economic group difference in health within countries and then comparing this difference between countries, the method commonly used.

There are a number of ways in which the policies of different welfare states could influence the composition of apparently similar socio-economic groups. One example is the extent to which children, irrespective of background, are able to achieve their educational potential and then a job matching this ability. In a meritocratic society, the achievement of socio-economic position will reflect ability, irrespective of background, and there will, therefore, be a greater variation in ability, between social groups, than in a society with less social mobility. Importantly for studies of health equity, if ability were to have an impact on health that was independent of socio-economic position, then in a meritocratic society there would also be a concentration of ability-related health in higher socio-economic …

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