Letter to the editors

To the editors:

I was pleased that you dedicated four pages to an extremely important subject in Inequality: Bad for your Health (Jan/Feb 2008), and that you chose Professor Kawachi to discuss the subject. There is no doubt that Dr. Kawachi's articles on social capital and his efforts on behalf of our discipline have put social epidemiology on the map. However, as a social epidemiologist with ten years of research on politics and population health, I have to disagree with the statement that "the more egalitarian the country, the healthier its citizens tend to be. But that's about as much as we can say. I'm not aware of really careful comparative studies."

I am attaching a list of articles in this area of social epidemiology to give you a flavor for the nature of this research. The quality of the studies is not particularly worse than in other areas of social epidemiology. Basically, politics matter, but generalizations across periods and outcomes are hard to make. The superiority of social democracies is not always clear as they are often difficult to distinguish from corporatist and even liberal states, for example, in the reduction of class inequalities or in outcomes such as infant mortality.

I also would like to add to the comment on the WHO Commission on Social Determinants of Health. The Employment Conditions subgroup of which I am part has been conducting comparative analyses on politics and health, which are due to be published next year.

—Carles Muntaner, University of Toronto

Benach, J., Muntaner, C., Santana, V. (in press) Employment Conditions and Health Inequalities: A Global Perspective.

Chung, H., Muntaner, C. (2007) "Welfare state matters: A typological multilevel analysis of wealthy countries," Health Policy 80(2), 328-339.

Chung, H., Muntaner, C. (2006) "Political and welfare state determinants of infant and child health indicators: An analysis of wealthy countries," Social Science and Medicine 63 (3), 829.

Espelt, A., Borrell, C., Rodriguez-Sanz, M., Muntaner, C., Kunst, A., Isabel Pasarin, M., Benach, J., Schaap, M., Navarro, V. (2008) "Inequalities in health by social class dimemsions in European contries of different political traditions," International Journal of Epidemiology 2008, 1-11.

Muntaner, C., Borrell, C., Kunst, A., Chung, H., Benach, J., Ibrahim, S. (2006) "Social Class Inequalities in Health: Does Welfare State Regime Matter?" In Raphael, D., Bryant, T., Rioux, M.H., eds., Staying Alive: Critical Perspectives on Health, Illness, and Health Care. Toronto: Canadian Scholars Press.

Muntaner, C., Lynch, J.W., Hillemeier, M., Lee, J.H., David, R., Benach, J., et al. (2002) "Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries," International Journal of Health Services 32(4), 629-656.

Navarro, V.C., Borrell, C. Benach, J., Muntaner, C., and Quiroga, A. (2007) "El impacto de la Politica en la Salud," Salud Colectiva 3(1), 9-32.

Navarro, V., Muntaner, C. (2006) "Political and economic determinants of population health and well-being: controversies and developments," Sociology of Health and Illness 28(7), 992-995.

Navarro, V., Muntaner, C., Borrell, C., Benach, J., Quiroga, A., Rodriguez-Sanz, M., et al. (2006) "Politics and health outcomes," Lancet 368(9540), 1033-1037.

Navarro, V., Borrell, C., Benach, J., Muntaner, C., Quiroga, A., Rodriguez-Sanz, M., et al. (2003) "The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950-1998," International Journal of Health Services 33(3), 419-494.