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Tilly's Durable Inequality and health inequality in USA: when the categories do not match and the mechanisms do not work
  1. Luisa N Borrell
  1. Correspondence to Luisa N Borrell, Department of Health Sciences, Graduate Program in Public Health, Lehman College, CUNY, 250 Bedford Park Boulevard West, Gillet 336, Bronx, NY10468, USA; luisa.borrell{at}

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Health inequalities are ubiquitous around the world.1 Thus, fresh perspectives to tackle inequalities are always welcomed by the research community invested in reducing and eventually eliminating health inequalities. Lorant and Bhopal discuss the ethnic and socioeconomic health inequalities in Europe where immigration is an important contributor to ethnic diversity. Specifically, they examine (1) how ethnicity and socioeconomic status interact to produce inequality and (2) the role of discrimination in this interaction.2 To elucidate ways to reduce these ethnic and socioeconomic health inequalities, Lorant and Bhopal use Charles Tilly's Durable Inequality theory (DIT).3 This social theory proposes that (1) socially constructed categories create or sustain inequality through four mechanisms: exploitation, opportunity hoarding, emulation and adaptation; (2) inequality is established at the organisational rather than the individual level.3 These categories (ie, men/women, majority/minority, rich/poor) could be classified as external (majority/minority) and internal (high/low socioeconomic position). Thus, the exploitation and opportunity hoarding mechanisms create inequality through matching of internal and external categories (ie, pairing categories such as minority/poor) within organisations to reinforce inequality, and thus making it durable. By contrast, emulation …

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  • Competing interests None.

  • Provenance and peer review Commissioned; not externally peer reviewed.

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