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Wilkinson and Pickett's1 (WP) theory has relative deprivation as a core mechanism for why income inequality impacts health in societies. A number of recent studies, including in JECH, have thus contrasted the health impact of relative to absolute deprivation.2 ,3 However, it is a false contrast I argue. This is because supposed absolute deprivation has its roots in a theory of relative deprivation.4 ,5 Further it is not only WP's theory that has relative deprivation as its core mechanism. Materialist/structural theory, as outlined in the very well-known Black report on health inequalities, does as well.6 Absolute deprivation is often defined as one's material standard of living up to some set level, for example, a subsistence level and as one's material standard of living independent of that of others.3 However, the Black report discusses in detail why materialist/structural theory sees the unequal access due to social class of economic and other resources as the key driver of health inequalities because it deprives people of contemporary standards of living.6 So there is a clear endorsement of deprivation as relative and a move away from notions of absolute deprivation and health in the report.
There is nothing fixed about levels of physical well-being. They have improved in the past and there is every likelihood that they will improve in the future. But class inequalities persist in the distribution of health as in the distribution of income or wealth, and they persist as a form of relative deprivation. (ref. …
Funding FP is funded by the MRC (MC_UU_12017/7).
Provenance and peer review Not commissioned; externally peer reviewed.