How and why do interventions that increase health overall widen inequalities within populations?

Abstract

The second major pathway through which social inequality affects public health is through the cumulative effects of advantage and disadvantage on broad population groups. This chapter presents a theoretical model for this, showing how in the presence of social inequalities, even interventions designed to improve health can widen health disparities between groups. For example, requiring cancer screening at medical examinations might be a laudable public health intervention, but in a society where not everyone is covered by health insurance, it tends to widen health disparities even as it improves overall health. The chapter also examines the inverse care law which states that ‘the availability of good medical care tends to vary inversely with the need for it in the population served’.