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The United States has the dubious distinction of ranking first among industrialized nations in inequalities in both income and wealth. It also manifests poorer health than many other developed nations and has experienced growing socioeconomic inequalities in health. This chapter draws attention to ways that inequality both shortens and impairs people's lives by focusing on premature mortality and functional disability. It measures health inequity as the disparity in these health outcomes across race/ethnicity, gender, and income group, as experienced in representative samples of the U.S. population. The results give a sense of both the relative unfairness and the burden of poor health in the United States. The chapter argues for the assessment of the full impact of disparities in health across the social gradient, not just on those at highest risk.

Chapter 3 explores the contribution of the lifecourse approach and social gerontology to understanding mental health outcomes in later life. It also explores the role played by health and social inequalities. By bringing these perspectives together the Chapter makes visible the ways in which lifecourse inequality and adversity e.g. childhood abuse, create and/or amplify risks to mental health in later life. It also exposes the embedded and structural nature of causative mechanisms. Health inequalities have profound implications for mental health. People from disadvantaged socioeconomic backgrounds suffer disproportionately from common mental disorders, such as depression, across the whole lifecourse. They are also exposed to higher levels of chronic psychosocial stress which, independently and additively, undermines mental wellbeing. These effects are cumulative over the longer term and in more unequal societies; also by exposure to discrimination and oppression. These arguments challenge the dominance of the ‘inevitable decline’ model of ageing exposing a more nuanced complex set of intersecting risks to mental health that are structurally located and socially produced. The role of policy in addressing health inequalities and their social determinants was a key dimension of mental health policy until 2011; since then it has become increasingly uncoupled from the policy agenda.

This chapter tells the story of Cora, who has been on AFDC all her adult life. She began using AFDC twenty-four years ago and has continued, without a break, ever since. In so many respects, her life mirrors our image of the classic welfare stereotype. She comes from a poor family and will leave her children — there are six of them — with a legacy of poverty and neglect that they will not be able to shake. The children have no role model in their mother of a working, productive member of society. Neither do they have a model of a law-abiding citizen. Cora never had these role models either, and for years she has lived in the projects where she is surrounded by poverty, crime, and drug abuse.

This chapter addresses the role of control beliefs in socio-economic differences in health and provides support for the assumption that low control beliefs might be fundamental mediators in the association between low socio-economic status and poor health. It begins with a socio-historical background to the unhealthy psychological profile in lower socio-economic status groups. It then presents evidence for low control beliefs being, at least partially, rooted in both childhood and adulthood socio-economic circumstances, and the possibility that these beliefs might also be related to the wider socio-economic environment, as defined by neighbourhoods and countries. The chapter presents evidence for low control beliefs being related to heightened risks of disease through varying pathways. It quantifies the contribution of low control beliefs to the socio-economic status-disease association. The possibility that control beliefs may be involved in status attainment processes and the consequences of this for a potential influence of indirect selection are then discussed. Other remaining questions, such as conceptual and empirical issues regarding the control concept, are addressed in the penultimate section. Finally, implications for, and difficulties of, efficient and effective interventions are discussed.

The health of Roma people is significantly worse compared to the majority European population. Lower use of health services may involve choice on the part of the Roma or unresponsiveness or discrimination on the part of health care providers. There are contrary views on whether to reform mainstream services, or set up alternative services, but any intervention that reinforces ideas of difference may be politically divisive in some countries. The health needs of the diverse Roma population lack attentions, given the absence of research and the lack of advocacy on their behalf. Safeguarding the human rights of their Roma communities is now one of the criteria for the acceptance of a country into the European Union.

People with low socio-economic status (SES) have poorer health prospects compared to people with high socio-economic status. This chapter explores the hypothesis that personal psychosocial resources are important mediators for these effects. In particular, coping ability, i.e., the individual's capacity to cope with life circumstances, is assessed as a possible pathway. First, it presents different concepts embracing the availability of personal psychosocial resources and then reviews the theoretical background for stating that these factors may mediate socio-economic effects on health. In a next step, possible psychobiological mechanisms are explored and some recent empirical data supporting these assumptions are presented. Finally, the chapter discusses implications for interventions in relation to whether intervention on psychological factors is desirable, possible or even necessary if the aim is to reduce negative health effects of low SES.

This chapter examines the patterning of ethnic inequalities in health in Great Britain. It discusses some of the assumptions that have underpinned much of the research and policy debate in relation to ethnic differences in health, and illustrates how far such differences are likely to be a consequence of the social inequalities faced by minority ethnic people in Britain. The chapter demonstrates how socioeconomic inequalities are too-readily dismissed as a potential explanation for ethnic inequalities in health, and shows how experiences of racial harassment and discrimination might also lead to an increased risk of poor health.

This chapter assesses the central importance of health, and in particular mental health, to a sense of wellbeing. It considers the factors that negatively impact mental wellbeing of migrant young people not so much in terms of presenting symptoms and biomedical responses, but largely as products of systems and structures that are incompatible with their lives and aspirations. The chapter highlights not only how poor health outcomes are often products of immigration and social care structures, but also how health services are no longer safe, neutral spaces. Instead, in the contemporary hostile environment, health services can act as additional arms of immigration control and surveillance systems. The chapter then discusses the controversial logic in the clinical use of anti-depressants and other drugs to manage conditions that are essentially socially and politically constructed, as well as the incursion of the criminal justice system into the arena of addiction and behavioural disorders.

Social Security (SS) benefits are the most important component of the income of a large fraction of older Americans. A significant fraction approach later life relying heavily on SS benefits. Persons in poor health in old age have a higher-than-average probability of having experienced low earnings while in the labor force, increasing the risk of having low SS benefits in retirement. While the progressivity of the SS benefit formula provides a safety net to support low-wage workers in retirement, a noticeable fraction still have income below the poverty level in their last years. In general, low assets and low income in old age are strongly related to poor health. We explore this nexus and describe the relationship between SS benefits and the exhaustion of nonannuity assets near the end of life. We examine the relationship between the drawdown of assets between the first year an individual is observed in the AHEAD data (1995) and the last year that individual is observed before death, and that individual's health, SS benefits, and other annuity benefits. SS and defined benefit pension benefits are strongly “protective” of nonannuity assets, with a negative relationship between these income flows and the likelihood of exhausting nonannuity assets.

This introductory chapter provides an overview of the relationship between health and housing, regional disparities and responses across England, Wales, and Scotland in the provision of health and social care and local authority commissioning. It considers how the Municipal Corporations Act (1835) led to the establishment of elected town councils. In the mid- to late 20th century, municipalisation gave way to centralised government, which subverted the autonomy of local authorities. Currently, social care is provided and funded by local authorities and private funders. The main objective of social care is to help people to live well and happily, and live as long as they can. This person-centred approach is in contrast to the systems that have been developed to support the health care needs of people. In 2020, poverty still remains a key driver of poor health and wellbeing.

This chapter examines evidence from the UK to assess whether COVID-19 and lockdown harms are housing diseases. It focuses on poor housing conditions, such as overcrowding and its relationship with poor health, in order to analyze the ongoing harms caused by the pandemic and factors that inhibit abilities to contain it. It also looks at issues concerning the shortage of space, lack of bedrooms, and poor-quality housing to mental health, noting that much of the population are staying at home during lockdowns. The chapter explains that COVID-19 is a disease that exposes vulnerabilities in the UK housing system, in both the public sector and the private market. It points out that the UK has had among the highest COVID-19 death rates in the world.

This chapter focuses on palliative care in acute hospitals in Great Britain. Hospitals are not really set up to deal with long-lasting poor health and chronic disease and most of the staff working in acute hospitals do not have any formal training for palliative care. This situation may soon change as clinicians coming through nursing and medical schools will have exposure to palliative care teaching, which is already being embedded in the training of allied healthcare professionals, pharmacists, and others working in clinical roles. This chapter also discusses the qualities that can help health professionals thrive in acute hospitals.

This chapter highlights the importance of talking about the declining life expectancy and poor health in the United States. In 2018, the National Center for Health Statistics reported that, between 2016 and 2017, US life expectancy dropped from 78.7 to 78.6 years—the third consecutive year life expectancy in the United States has declined. Yet, somehow, these data were not headline news every day for weeks after their release. They did not move instantly to the center of national discourse. If people continue to ignore, even accept, their collective poor health, it is in part because they have accepted changes in the past 30 years—such as growing income inequality—that have made their health worse. It has lulled people into thinking their poor health is somehow inevitable, rather than a relatively recent development that can be linked to certain political policies, the reversal of which could change the trajectory of their health. Making this change means first talking honestly about where Americans are, and how they got here, so they can eventually get their health to where it should be.

This chapter looks at the health and lifestyle factors among tea garden labourers in West Bengal. Tea garden labourers enjoy access to some free facilities like education for children, medical facilities, piped drinking water, housing, and subsidised food. Yet they still suffer from several health problems. This might be due to insufficient or inadequately maintained facilities, poor lifestyles, or a mixture thereof. The chapter then focuses on the work environment, lifestyles, and physical health status of Oraon tea garden labourers of Jalpaiguri district, West Bengal. The results reveal that around 60 per cent of the labourers are underweight, despite reporting that they were getting sufficient food to eat. Poor hygienic practices may explain these results. Anaemia was also high for both sexes. Ultimately, the overall health condition of the labourers may be explained by the poor health lifestyles that they have adopted in response to their work environment.

This chapter examines the significant overlap between the risk factors for offending, poor mental health and substance use, and assessed risk factors. Research on the prevalence of mental disorders in youth justice has increased steadily over the years but it remains limited compared to the researches on adult mental disorders. In addition, mental health treatment within the youth justice system is lacking for those in need. In research conducted in 2003, only 20% of youths with mental disorders were receiving treatment. In terms of assessment and clinical assessment tools, it is necessary that the purpose and the feasibility of assessments such as needs and risk assessment should be considered. In addition to discussing the prevalence of mental disorders and the principles of assessing such disorders in youths, the chapter also discusses the different types of mental disorders that may be associated with offending. Such disorders are marked by anomalous perceptual experiences, abnormal reasoning, and motivational factors. Some of the disorders prevalent in children and that may result to violence and offending is: oppositional disorder, conduct disorder and ADHD; depression anxiety and PTSD; autism-spectrum disorders; and early on-set psychosis. In working with young people who offend, regardless of whether they are addressing offending behaviour or mental health problems, the developmental and cognitive factors significant to their age groups should be considered as interventions designed for adults prove to be alienating for youths.

This chapter explains how the world that faced COVID-19 was not a world free of existential threats, merely from the widespread knowledge of them. The pandemic revealed just how vulnerable we have always been, and how vulnerable we will remain unless we learn its lessons. The first step to doing so is understanding the ways in which the world is still unhealthy and the forces which enable this poor health. This means looking at health disparities, which emerge from the misalignment of the structures that underlie health—the social, economic, political, and geographic factors which unfold across time and distance to shape our world. Creating a healthy world means engaging with health on this level—and we cannot prevent the next pandemic without creating a healthy world. The chapter discusses how we can do so, by first looking at the ways we have fallen short. The challenges of widespread disease, the proliferation of unsafe behaviors like smoking, and other forms of preventable mortality all speak of a world that is still unhealthy. The chapter then looks at how these challenges intersected with COVID-19. Finally, it considers the role global cooperation and international institutions played in addressing COVID-19, and their importance for creating a better future for health.

This chapter evaluates the central role of compassion in preventing the contagion next time. During COVID-19, compassion revealed just how many people in the United States are deeply vulnerable to poor health. This vulnerability was often a product of underlying health conditions. There are many health challenges in the United States which annually generate a level of mortality comparable to that of COVID-19, challenges like obesity and addiction. However, America have not addressed these challenges with anywhere near the level of urgency they brought to bear in addressing COVID-19. A key reason why is, arguably, because these challenges are not infectious, making it possible for the public at large to escape the visceral feeling of vulnerability to a disease which transmits through the air and can strike anybody. Instead, they see these challenges somehow as niche issues, the niche being the lives of the marginalized and disadvantaged groups. This outlook allows them to evade the feeling of common humanity which gives rise to compassion. Compassion, then, depends on the understanding of the true nature of health and of the shared vulnerability to disease.

This chapter examines the impact of health inequalities on addiction and how the recommendations of the Marmot Review could influence recovery from addiction. The Marmot Review was tasked with devising strategies to reduce health inequalities in England, and rightly recognised that health equality requires a debate about what kind of society we want to live in. When considering societies as a whole, there is a clearer relationship between poor health outcomes and societal inequality; rich countries with a steep social gradient do worse than poorer, but more equal, countries. The chapter first provides an overview of factors that cause substance use and addiction before discussing the role of early life adversity in addiction and the link between inequality and addiction. More specifically, it explains how unequal societies lead to addiction and goes on to consider how society can support recovery from addiction.

Elderly Americans who live with people under age 18 have lower life evaluations than those who do not. They also experience worse emotional outcomes, including less happiness and enjoyment, and more stress, worry, and anger. In part, these negative outcomes come from selection into living with a child, especially selection on poor health, which is associated with worse outcomes irrespective of living conditions. Even with controls, the elderly who live with children do worse. This is in sharp contrast to younger adults who live with children, likely their own, whose life evaluation is no different in the presence of the child once background conditions are controlled for. Parents, like elders, have enhanced negative emotions in the presence of a child, but unlike elders, also have enhanced positive emotions. In parts of the world where fertility rates are higher, the elderly do not appear to have lower life evaluations when they live with children; such living arrangements are more usual, and the selection into them is less negative. They also share with younger adults the enhanced positive and negative emotions that come with children. The misery of the elderly living with children is one of the prices of the demographic transition.