The evolution of health inequalities in the western world: From early origins to modern times

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Abstract
Background: Throughout human history, socioeconomic inequalities in health are shaped by interlinked structural changes, like emerging agriculture and industrialism, demographic and economic transitions, as well as epidemics of infectious diseases, catastrophes, and climate changes. Key questions include when health inequalities emerged, and how they evolved from early communities until modern societies. Method : Based on original sources, research literature, reviews, and their critical analysis, this historical review focuses on the evolution of health inequalities, their appearance and advancement. Availability of sources limits the scope to Europe and the western world. Findings : Early hunter-gatherer communities were socioeconomically relatively equal, likely lacking major health inequalities. As agriculture emerged in the neolithic time since 10000 BCE, societies became more prosperous and unequal. In medieval societies, with deep socioeconomic inequalities, health inequalities were presumably constrained by infectious diseases and catastrophes hitting populations “democratically”. John Graunt and William Petty showed in Britain novel socioeconomic and health inequalities emerging with early industrialist capitalism. By the “Revolutions of 1848” health inequalities encompassed industrial countries as shown by Rudolf Virchow and Edwin Chadwick. In the Black Report (1980) and present-day research health inequalities appear ubiquitous and often widening. Conclusions : The evolution of health inequalities follows both the constancy hypothesis, suggesting omnipresent health inequalities where social inequalities prevail, and the convergence-divergence hypothesis, suggesting variations in health inequalities from prehistory to modern time. A conundrum is, to what extent health inequalities were constrained by epidemics and catastrophes. Currently, health inequalities are a world-wide public issue to be tackled with egalitarian policies.

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