North-south divide in social inequalities in Great Britain
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《英国医生杂志》
EDITOR—The message we hoped readers would take from our paper is that the United Kingdom has large health inequalities in terms of social class, geography, and geography within the social class inequalities. We therefore concur with Bland's analysis, as his figures confirm this point. The differences between regions within each social class, although smaller than the differences between the social classes, are substantial.
Bland and Croft criticise the subjective nature of the self rated health measure. Several studies have shown that even very simple self rated health scales are powerful and reliable predictors of subsequent mortality across all social groups. 1 2 Self rated health is not simply a crude and pragmatic proxy for more objective measures, however: it is a direct way of capturing people's perceptions of their own health, by using their own criteria. Our findings for different social groups are therefore likely to be the result of a combination of factors: prevalence of disease, definitions and expectations of health, demands of everyday life, quality of available medical care, and acknowledgement and recall of symptoms. 3
The issue of over-reporting of "actual" poor health has been addressed elsewhere. People in manual classes are less likely than those in non-manual classes to report their health as poor despite having signs of disease on examination.4 This certainly seems to have been Cummins's experience in Wirral. With respect to the regions, further research is required. Our findings are consistent with previous findings based on mortality data,5 with the possible exceptions of Scotland, where self rated health was better than might have been expected, and Wales, where it was worse.
Our study gave an overview of social inequalities in self rated health regionally. Even greater inequalities are likely to emerge when considering self rated health locally.
Tim Doran, clinical lecturer in public health medicine
timdoran@liverpool.ac.uk
Frances Drever, visiting senior research fellow, Margaret Whitehead, W H Duncan professor of public health
Department of Public Health, University of Liverpool, Liverpool L69 3GB
Competing interests: None declared.
References
Idler E, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behaviour 1997;38: 21-37.
Burstr?m B, Fredlund P. Self-rated health: is it a good predictor of subsequent mortality among adults in lower as in higher social classes? J. Epidemiol Community Health 2001;55: 836-40.
Blane D, Power C, Bartley M. Illness behaviour and the measurement of class differentials in morbidity. J R Stat Soc 1996;159: 77-92.
Blaxter M. Health and lifestyles. London: Routledge, 1990.
Leyland A. Increasing inequalities in premature mortality in Great Britain. J Epidemiol Community Health 2004;58: 296-302.
Bland and Croft criticise the subjective nature of the self rated health measure. Several studies have shown that even very simple self rated health scales are powerful and reliable predictors of subsequent mortality across all social groups. 1 2 Self rated health is not simply a crude and pragmatic proxy for more objective measures, however: it is a direct way of capturing people's perceptions of their own health, by using their own criteria. Our findings for different social groups are therefore likely to be the result of a combination of factors: prevalence of disease, definitions and expectations of health, demands of everyday life, quality of available medical care, and acknowledgement and recall of symptoms. 3
The issue of over-reporting of "actual" poor health has been addressed elsewhere. People in manual classes are less likely than those in non-manual classes to report their health as poor despite having signs of disease on examination.4 This certainly seems to have been Cummins's experience in Wirral. With respect to the regions, further research is required. Our findings are consistent with previous findings based on mortality data,5 with the possible exceptions of Scotland, where self rated health was better than might have been expected, and Wales, where it was worse.
Our study gave an overview of social inequalities in self rated health regionally. Even greater inequalities are likely to emerge when considering self rated health locally.
Tim Doran, clinical lecturer in public health medicine
timdoran@liverpool.ac.uk
Frances Drever, visiting senior research fellow, Margaret Whitehead, W H Duncan professor of public health
Department of Public Health, University of Liverpool, Liverpool L69 3GB
Competing interests: None declared.
References
Idler E, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behaviour 1997;38: 21-37.
Burstr?m B, Fredlund P. Self-rated health: is it a good predictor of subsequent mortality among adults in lower as in higher social classes? J. Epidemiol Community Health 2001;55: 836-40.
Blane D, Power C, Bartley M. Illness behaviour and the measurement of class differentials in morbidity. J R Stat Soc 1996;159: 77-92.
Blaxter M. Health and lifestyles. London: Routledge, 1990.
Leyland A. Increasing inequalities in premature mortality in Great Britain. J Epidemiol Community Health 2004;58: 296-302.