Volume 76 Number 3, 1998
Epilogue
Robert P. Huefner and Norman J. Waitzman
The relations between health and socioeconomic status (SES) have important implications for health and for broader issues of economic strength and social policy. The studies reported here help us to understand several dimensions of the relation between socioeconomic conditions and health, but there remains considerable uncertainty about their meaning and about what the remedies should be. Research can advance our knowledge, but full understanding and complete consensus likely will continue to elude us. Nevertheless, these studies can help policy makers focus on what else needs to be known and on the possible responses. Does the negative correlation of health with socioeconomic disparities justify efforts to reduce their impact? Or is Syme correct in stating that attempts to reduce political, social, or economic inequalities are fruitless, leading to the conclusion that they should be addressed through limited projects like education for "control of destiny"? To use Marmot's terminology, should intervention be "upstream" or "downstream"? Another issue concerns the possible focus of interventions: federal, state, or local. The political acceptability of interventions is yet another issue: should questions of justice be raised to support interventions, or is the Dutch consensual approach (described by Whitehead), which eschews such argument, more likely to achieve success?
Policy that addresses disparities in health among socioeconomic groups faces the same uncertainty as other critical policies. We must explore and experiment, as well as prepare ourselves for unexpected opportunities, in order to make progress and understand future possibilities. Successful intervention is likely to require persistence, skill, and a good deal of luck, as has been demonstrated in the more tractable, yet still only partially resolved, matter of tobacco policy. Progress with the far thornier problems of socioeconomic disparities will require research, discussion, and experimentation as well as more persistence, skill, and luck.
Robert P. Huefner
Norman J. Waitzman
University of Utah
