Mackenbach Johan P
Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Scand J Public Health. 2017 Mar;45(2):113-120. doi: 10.1177/1403494816683878. Epub 2016 Dec 21.
Social-epidemiological explanations of health inequalities usually take the existence of social inequality as a given and ignore the fundamental questions of why social inequality exists in the first place and why it is so persistent. I review here theories of the explanation of social inequality to identify the processes and/or structures responsible for its persistence.
This paper is a review of the relevant sociological literature.
The sociological literature suggests that what persists over long periods of time is not a specific manifestation of social inequality but a 'meta-phenomenon': the fact that there are different social positions, that these social positions give access to different levels of resources in some graded way and that the distribution of individuals over social positions follows rules that create inequalities in the opportunities for achieving a more advantaged social position. The durability of social inequality in this generic form can then be understood from the persistence of the underlying mechanisms and processes - for example, humans are driven by self-interest, while most objects of their striving are in short supply, therefore a struggle for rewards is present in all societies; humans are unequally endowed, therefore some are more successful in this struggle for resources than others; and the inequalities resulting from these individual level actions are structurally fixated through the intergenerational transmission of (dis)advantage, various societal institutions, and cultural factors.
The sociological literature suggests that some mechanisms producing and perpetuating social inequality are more 'benign' than others. Health inequalities may be more than a consequence of social inequality and may play a more profound part by amplifying social inequalities.
健康不平等的社会流行病学解释通常将社会不平等的存在视为既定事实，而忽略了社会不平等最初为何存在以及为何如此持久的根本问题。在此，我回顾社会不平等的解释理论，以确定导致其持续存在的过程和/或结构。
本文是对相关社会学文献的综述。
社会学文献表明，长期持续存在的并非社会不平等的具体表现，而是一种“元现象”：存在不同的社会地位，这些社会地位以某种分级方式使人获得不同水平的资源，且个体在社会地位上的分布遵循一些规则，这些规则在获得更有利社会地位的机会方面造成不平等。这种一般形式的社会不平等的持久性可以从潜在机制和过程的持续存在来理解——例如，人类受自身利益驱动，而他们追求的大多数目标都供不应求，因此所有社会都存在对回报的竞争；人类的天赋不平等，因此在这场资源竞争中，有些人比其他人更成功；这些个体层面行为导致的不平等通过（不利）优势的代际传递、各种社会制度和文化因素在结构上得以固定。
社会学文献表明，一些产生并使社会不平等长期存在的机制比其他机制更“温和”。健康不平等可能不仅仅是社会不平等的结果，还可能通过加剧社会不平等发挥更深远的作用。
