ABSTRACT
Introduction Two decades have passed since the Black Report (DHSS 1980) first revealed the gap in health as well as wealth, from birth to old age, which divides the rich from the poor. Whilst research continues to extend, refine and develop its four-fold explanatory frame of reference on class inequalities-from the critical reassessment of artefact (Bloor et al. 1987) and health-selection explanations (West 1991; Blane et al. 1993), to the ‘biological programming’ of social disadvantage in utero (Barker 1991), and the importance of longitudinal research across the lifecourse (Wadsworth 1991, 1997; see also Blaxter in this volume)—researchers and policy-makers alike must now confront a central paradox; namely, that once a certain level of material wealth has been reached, and the ‘epidemiological transition’ completed, other more diffuse and intangible factors come into play as the main determinants of socially patterned disease and illness in advanced western societies. Central to these developments, has been a growing interest in the so-called ‘psychosocial pathways’ to disease, including the impact of relative versus absolute deprivation and the corrosive effects of an increasingly ‘individualised’ society (i.e. an ‘unravelling’ of the social fabric, and a dissolution of communal bonds which bind members of society together) (Wilkinson 1996).
