International Journal of Epidemiology 2000;29:1099
© International Epidemiological Association 2000
Book Review |
The Widening Gap.
M Shaw, D Dorling, D Gordon, G Davey Smith (eds). Bristol: The Policy Press, 1999, pp.267, £16.99. ISBN: 1–86134–142–3.
‘... in contemporary Britain unequal chances of death are interwoven, in social and spatial terms, with unequal chances in life, in terms of education, employment, income and wealth.’ (p.5)
The Widening Gap is a brilliant book about the socially just distribution of resources and public health. It is one of the best and most powerful examples of how epidemiological data can be brought to bear to reveal and understand the enormous geographical and social inequalities in health that exist in Britain. After a brief introduction that provides some political and historical background, the authors set about describing (Chapter 2), explaining (Chapter 3) and examining trends (Chapter 4) in ‘the gap’ that exists between the health of the best and worst-off million people in Britain. In Chapter 5 they discuss policy options for narrowing this health gap, and are refreshingly candid about challenging those in power to account for the past and devise plans to reduce health inequalities in the future. In fact, Appendix A provides a complete list of the politicians representing each constituency in Britain, their party affiliation, the standardized mortality ratio and the per cent of avoidable mortality in that politician's constituency. There are 15 such constituencies that comprise the areas where the worst-health million live. The greatest concentration of poor health areas is around Glasgow, with others in Liverpool, Manchester, Newcastle, and Southwark North and Bermondsey in London. The 13 constituencies that comprise the areas where the best-health million live are concentrated in the southeast of England, except for one part of Sheffield in the Midlands.
In investigating the health gap that exists between the best and worst-health areas of Britain, Mary Shaw, Danny Dorling, Dave Gordon and George Davey Smith bring a prodigious amount of health and social data to bear. There are more than 100 tables and figures that describe everything from inequalities in mortality, neurotic disorders, long-standing illness and smoking, to unemployment, child poverty, education and wealth. One of the great achievements of this book is that the reader is not over-burdened by wading through this mountain of information. Instead, the authors employ innovative use of maps and figures, and well-designed tables that make the book both an important resource for academic reference but also useful and accessible to non-expert audiences.
This book is full of startling facts—here are a few that particularly grabbed my attention:
- Men and women living in the worst-health areas were 2.5 times more likely to die prematurely compared to the best-health areas
- Among the worst-health areas there were 4.2 times more children in poverty than in the best-health areas
- Infant and child mortality is twice as high in the worst-health areas
- There were 32% of men in the worst-health areas who were unemployed or permanently sick and unable to work—in the best-health areas there were 7.5%
- Compared to 1981, there were 4% fewer women working in the worst-health areas in 1991—in the best-health areas there were 10% more women working in 1991
- In 1981, the child poverty ratio comparing the worst to best-health areas was 3.5. In 1991 it had almost doubled to 6.2.
The authors of The Widening Gap have combined the highest levels of scholarship, exhaustive data presentation, understandable analysis, and policy discussions with a straightforward style that make this book an important contribution to the literature on social inequalities in health. In fact, I think it provides a marvellous template for similar efforts to investigate the worst and best-health million in other countries around the world.
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  W. Winkelstein Jr. From the Editor Am. J. Epidemiol., September 15, 2001; 154(6): 588 - 588. [Full Text] [PDF]
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