Wilkinson R G
J Soc Policy. 1989 Jul;18(3):307-35. doi: 10.1017/s0047279400017591.
The official figures which appear to show a widening of class differences in health in England and Wales during the post-war period have been controversial partly because they do not fit with common perceptions of what has happened to differences in the standard of living. As a result, a great deal of effort has gone into investigating suggested weaknesses in the decennial social class mortality data. Though initially plausible, the artifactual and selective explanations of the widening mortality differences which were put forward have not usually been borne out by closer investigations. The only fault in the broad picture presented by the official data which we do perhaps need to bear in mind is the tendency for a narrowing of mortality differentials among younger women to be masked by the widening among older women. This paper is an attempt to look at the other side of the coin--namely, to investigate trends in differences in the standard of living in relation to mortality differentials. It concludes that trends in mortality differences have not been related to trends in class differences in average earnings, but have been fairly clearly related to trends in relative poverty. Relative poverty and class differences in mortality declined before the war but have both increased, decade by decade, since the war. Younger women have perhaps been protected from the increase in relative poverty during much of the post-war period by their increased economic activity rates and the relative improvement in earnings of women in poorly paid manual occupations.
官方数据显示,在战后时期,英格兰和威尔士健康方面的阶层差异在不断扩大,这一数据颇具争议,部分原因在于它们与人们对生活水平差异变化的普遍认知不符。因此,人们投入了大量精力来调查十年一次的社会阶层死亡率数据中被认为存在的弱点。尽管最初看似合理,但所提出的关于死亡率差异扩大的人为因素和选择性解释,通常并未得到更深入调查的证实。官方数据呈现的大致情况中,我们或许确实需要牢记的唯一缺陷是,年轻女性死亡率差异缩小的趋势可能被老年女性死亡率差异扩大所掩盖。本文试图从另一方面来看待这个问题——即研究生活水平差异与死亡率差异相关的趋势。研究得出的结论是,死亡率差异趋势与平均收入的阶层差异趋势并无关联,而是与相对贫困趋势有相当明显的关系。相对贫困和死亡率的阶层差异在战前有所下降,但战后却逐十年增加。在战后的大部分时间里,年轻女性或许由于经济活动率的提高以及低薪体力劳动者中女性收入的相对改善,而免受相对贫困加剧的影响。