Relative deprivation: a key theory for health inequality research?

The Black report and relative deprivation

The Black report is the famous 1980 UK report on health inequalities. Its favoured theory for why health inequalities persisted and widened post WWII was structural theory (aka materialist). In some ways this is just Peter Townsend’s relative deprivation theory applied to health inequalities.  Townsend was one of the report’s authors and a leading thinker on why deprivation and poverty persisted in rich countries.  You can read his classic 1979  book “Poverty in the UK” for free.  While the empirical work is dated, the theoretical is still of contemporary importance. I would recommend chapters 27, 1 and 2 for understanding relative deprivation theory. Of course Townsend wrote lots more and this collection is well worth a read. Townsend’s theory has been particularly influential in measuring poverty and measuring area deprivation. Yet it also covers the whole social gradient, individual and household deprivation.

Defining relative deprivation

Townsend defined relative deprivation as “… the absence or inadequacy of those diets, amenities, standards, services and activities which are common or customary in society. People are deprived of the conditions of life which ordinarily define membership of society. If they lack or are denied resources to obtain access to these conditions of life and so fulfil membership of society, they are in poverty.”

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Death expectancy? For studying health inequality?

What’s the opposite of life expectancy? Well I think it might be death expectancy, the area above, rather than below, the survival curve. Say we have a lifetable where the last age is 110+. There are essentially 111 years of life in the lifetable. So death expectancy at birth is 111 minus life expectancy. I am sure you could derive this directly from lifetable elements and demographers have this sorted already. Let me know. Also note I took inspiration from this paper that looked at 100 minus life expectancy.

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The link between population health and health inequality

Is life expectancy increasing? Is health inequality decreasing? These are fundamental questions for population health.  It is thus natural to ask if life expectancy and inequality are related. The figure below shows they are. It compares life expectancy – average age at death – to the distribution of the age at death around this average (inequality). If everyone died at the same age there would be no inequality. So average years of life lost per death measures inequality. Higher life expectancy is associated with lower inequality.  Each dot is calculated from 5 years worth of data for a country, with 41 countries observed since 1950 (i.e. one dot is for Scotland in 1950-54).

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