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The widening gap: health inequalities and policy in Britain.
  1. FELICIA B LECLERE, Laboratory for Social Research and Department of Sociology
  1. University of Notre Dame, 913 Flanner Hall, Notre Dame, IN 46556, USA

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    The widening gap: health inequalities and policy in Britain. Mary Shaw, Daniel Dorling, David Gordon, George Davey Smith. (Pp 267; £16.99.) The Policy Press. ISBN 1-86134-142-3.

    The Whitehall Study and Black Report, both of which originate in Britain, set the stage for most modern research on the link between social class or socioeconomic status and health and mortality. Both demonstrated a strong and clear connection between socioeconomic status (the term most often used by researchers in the United States) and differential health outcomes. In Britain, the Black Report also became an important flash point in public policy. This book provides a clear and readable update on the trends in and the current status of health differentials by social class. The data brought to bear on the issues are wide ranging and rigorous in scope including census and mortality records, longitudinal studies of health and wellbeing, and variety of sample surveys. In addition, the authors explore a variety of explanations of these social class differences and provide direct and concrete policy recommendations.

    The book, however, is made much more interesting by its underlying agenda. The authors use two current research themes in public health research to structure their description and explanation of the social class differentials in health. The first theme is that health at all life stages is produced by influences over the life course and by different aspects of social class at each life stage. Thus, for instance, they structure the descriptive chapters around life course stages including infancy and retirement. The authors also highlight longitudinal explanations of social class differentials in health, such as health selection and inter-generational and intra-generational social mobility. The second theme they use throughout the book is that the geographical location of individuals works synergistically with individual factors to produce health. They implement this perspective in a unique way by identifying those areas of Great Britain with the poorest and best health that contain a million people respectively. They use these areas then as a descriptive device to track health differences such as mortality and long term limiting illness as well as socioeconomic determinants such as poverty and educational attainment. This method of presenting the data proves quite convincing. The important role of place and its social content are amply illustrated.

    The only disappointment of this book is the audience it targets. It would serve excellently in a graduate course on social epidemiology or public health policy. Alternatively, it is a good public health primer for policy makers or individuals without research experience in the area. The data are presented clearly with ample, albeit sometimes distracting, graphics and tables. Unfamiliar concepts are explained well and chapter summaries are provided. This simple clarity while useful for the intended audience is disappointing for researchers who are working in this area. The complexity of longitudinal explanations of health differentials, which are rooted in the past and present social geography of individuals, belies this simple treatment. These authors have made major contributions in other venues to this literature and a book length exploration of this research area would have been very exciting. In this case, however, the fault lies with the reader who wished for something that the authors never intended.