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‘If the Lord Almighty had consulted me before embarking upon Creation, I should have recommended something simpler’.1 Alfonso X ‘The Wise’ (1221–1284), Spanish King of Castile and León.
In their article, Mackenbach et al2 try to translate health into monetary figures in order to back up with economic arguments their advocacy of intersectoral actions to tackle health inequalities. The reduction of health inequalities by way of improving the health of the less educated—their levelling up approach—would lead to economic gains through its impact on labour participation, labour income, GDP, social security benefits, healthcare costs and total welfare. Taken at face value, the results are forceful: health inequalities across Europe-25 are responsible for more than 700 000 deaths per year, 33.5 million prevalent cases of ill-health, 20% of the total healthcare costs, 15% of the total costs of social security benefits and welfare losses that amount to 9.4% of the GDP (almost €1000 billion per year).
Simple numbers are attractive when they seem to capture complex phenomena in just a few quantitative magnitudes that are appealing to the mass media because they can easily hit the headlines. The implicit assumption behind the authors' calculations is that economic variables are independent …