Towards explaining health inequalities

Editor—Vågerö's editorial has opened up an issue that our paper on health inequality in men and women did not discuss in any detail.¹,² Research into health inequality now aims to move away from description and towards explanation. This means that measures of socioeconomic position need to be chosen with reference to hypotheses about how health inequalities are produced. In previous research on health inequality in women, inconsistency of results has forced us to question the assumption that the causes of health inequality are the same in men and women. This forces us to pay more attention to the appropriateness of our measures for our theories of how social structure acts on health.

We have carried out an explicit test of what researchers have in fact been implicitly thinking when they relate the health of married or cohabiting women to the occupational social class of their partners, as advocated by Vågerö. There is something about either the material or the cultural advantage or disadvantage of household circumstances that affects women's health more strongly than their own occupation. Also implicit is the assumption that there is a stronger correlation between the male (than the female) partner's occupationally defined social class and the general social and material advantage and lifestyle of the household. Given this hypothesis about the source of health inequalities in women, and the existence of an independent measure of household advantage, to rely on the husband's occupational class as a proxy for household advantage would not have been appropriate.

As the National Statistics' socioeconomic classification comes into use in British vital and official statistics and the 2001 census (including the next occupational mortality supplement), these issues will no doubt be debated at far greater length. We are pleased that Vågerö's editorial has opened up this discussion in such a timely fashion.