Shaw M, Dorling D, Gordon G, Davey-Smith G. Putting time, person and place together: the temporal, social and spatial accumulation of health inequality. Critical Public Health 2001; 11 (4): 289-304
It is now firmly established that there are social and spatial inequalities in health in Britain, and that these have been widening since the late 1970s/early 1980s. Since the publication of the hugely influential Black Report (DHSS, 1980) a growing body of research has documented the growth of health inequalities in Britain and many researchers have debated their cause. Our own research has drawn upon, and added to, this now substantial body of research. From this research we present data on the extent of health inequalities in Britain in both social and spatial terms. In the first section of the paper we present evidence of the widening health gap over time in two ways. First of all we look at how the geography of health inequalities has changed from the early 1950s to the late 1990s.We then look at inequalities in health at different points across the life course, from the cradle to the grave. In the second section of the paper we turn our attention to the processes that have contributed to the social and spatial accumulation of health inequalities and how these interact with the clustering of socioeconomic advantages that accumulate over the life course. We show the role of migration in producing and exacerbating geographical inequalities in health, and how migration itself can be seen as a response to socioeconomic conditions and circumstances. Finally, we end by considering the implications of our findings for policies that aim to redress health inequalities.