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Deprivation Is a Relative Concept? Absolutely!

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Deprivation Is a Relative Concept? Absolutely! JECH Online First, published on August 25, 2014 as 10.1136/jech-2013-203734 J Epidemiol Community Health: first published as 10.1136/jech-2013-203734 on 25 August 2014. Downloaded from Editorial group,3 so the contrast may be between Deprivation is a relative concept? the importance of deprivation with differ- ent reference levels rather than between Absolutely! absolute and relative. Indeed WP argue that relative derivation at the national Frank Popham level rather than a subnational level is more important given a stronger relation- ship between income inequality and ’ 1 ’ 23 Wilkinson and Pickett s (WP) theory has to test WP s theory. WP themselves health at the national rather than local relative deprivation as a core mechanism have argued that within country depriv- level.1 Of course WP’s theory uses abso- for why income inequality impacts health ation income scales in rich countries are 1 lute to describe international comparisons in societies. A number of recent studies, relative rather than absolute. of income and health however relative JECH ’ including in , have thus contrasted While researchers exploring WP s deprivation theory extends to inter- the health impact of relative to absolute income inequality theory have recognised national comparisons as well.45 23 ’ deprivation. However, it is a false con- Townsend s relative deprivation theory There are those who wish to retain fl ’ 8 trast I argue. This is because supposed they are most in uenced by Runciman s absolute concepts of deprivation, most absolute deprivation has its roots in a much cited study which focused on famously Amartya Sen in his work on cap- 45 ’ theory of relative deprivation. Further people s perceptions or feelings of depriv- abilities. However, this is a more complex ’ it is not only WP s theory that has relative ation relative to others. Often researchers use of absolute than the simple definition deprivation as its core mechanism. study the health impact of relative depriv- of absolute used in studies comparing Materialist/structural theory, as outlined in ation by transforming their deprivation relative to absolute deprivation. Sen9 the very well-known Black report on measure using a formula derived from argued that ‘Especially against the simplis- 6 ’ 3 health inequalities, does as well. Absolute Runciman s work. They then compare its tic absolute conceptualisation of poverty, fi ’ deprivation is often de ned as one s health effect to that of absolute depriv- the relative view has represented an material standard of living up to some set ation. However, as discussed, these entirely welcome change’ with his view level, for example, a subsistence level and deprivation measures are relative in the being ‘that absolute deprivation in terms as one’s material standard of living inde- first place rather than absolute measures. ’ 3 of a person s capabilities relates to relative pendent of that of others. However, the So researchers are effectively transforming deprivation in terms of commodities, Black report discusses in detail why a relative deprivation measure into incomes and resources’ (p.153). materialist/structural theory sees the another relative deprivation measure and Obviously WP’s income inequality unequal access due to social class of eco- then contrasting one relative deprivation theory emphasises relative deprivation as nomic and other resources as the key measure to another. Furthermore, being psychosocial deprivation leading to driver of health inequalities because it Runciman also rejected the idea that rela- stress and poor health behaviours and deprives people of contemporary stan- tive deprivation implied an absolute 6 thus poor health, rather than the direct dards of living. So there is a clear opposite. effects of deprivation of physical living endorsement of deprivation as relative conditions.1 However, materialist theory and a move away from notions of absolute …the notion of relativity implied by ‘ ’ and Townsend’s relative deprivation deprivation and health in the report. relative deprivation has led some writers to feel that there must be some theory have always incorporated physical, 4–6 There is nothing fixed about levels of wants or needs which could be termed social and status deprivation, as has http://jech.bmj.com/ 10 physical well-being. They have improved ‘absolute’ deprivation – wants, that is, long been recognised. For Townsend, in the past and there is every likelihood which are independent of the situation the contrast between his definition of rela- that they will improve in the future. But of any other person or group, and tive deprivation and Runciman’s was the class inequalities persist in the distribu- which can be assessed by appeal to some emphasis given to objective conditions of ‘ ’ tion of health as in the distribution ideal yardstick such as minimum need living compared to subjective perceptions ‘ ’ of income or wealth, and they persist as or subsistence level . But this idea of deprivation.411This contrast between breaks down under close scrutiny…. a form of relative deprivation. (ref. 6, feelings and conditions has featured in the p.109) The level of so-called absolute need can on October 1, 2021 by guest. Protected copyright. be just as well fixed at one level as health inequalities literature as well when ’ This emphasis on relative deprivation is another. (ref. 8, p.295) highlighting the difference between WP s not surprising as Peter Townsend was one income inequality theory and materialist ’ 12 ’ of the Black report’s authors. He was a So both materialist and WP s income theory. While Runciman s study focused key theorist for why deprivation is relative inequality theory have relative deprivation on subjective feelings of deprivation, ’ not absolute, and the originator of an theories at their core and both these rela- Townsend s work emphasised the actual influential relative deprivation scale that tive deprivation theories reject the idea of conditions of deprivation. has inspired many other relative depriv- absolute deprivation. This suggests that fl Subjective (or collective sentiment ation scales.457Yet these deprivation there is a need to re ect on what the about) deprivation is a valuable analyt- scales, or their proxies, are continually actual contrast is and what researchers are aiming to study when claiming to contrast ical or explanatory variable. However, it treated as absolute deprivation in health cannot be fully assessed independently absolute to relative deprivation. Often the inequalities studies that aim to contrast of actual deprivation, and the latter relative and absolute deprivation in order reference level or group of the two could be argued to be primary in under- deprivation measures may be different, standing a whole range of social and one (usually the untransformed ‘absolute’ Correspondence to Dr Frank Popham, MRC/CSO psychological phenomena. (ref. 11, p.35) deprivation) may be at the national level Social & Public Health Sciences Unit, University of 8 Glasgow, 200 Renfield Street, Glasgow G2 3QB, UK; while the other may be subnational Runciman’s book was a study of the [email protected] whether this be a geographical level or a degree of (mis) match between actual Copyright Article author (or their employer)Popham F. J Epidemiol 2014. Community Produced Health byMonth BMJ 2014 Publishing Vol 0 No 0 Group Ltd under licence. 1 J Epidemiol Community Health: first published as 10.1136/jech-2013-203734 on 25 August 2014. Downloaded from Editorial conditions of deprivation and people’s deprivation at their core. This challenges of coronary heart disease mortality after adjustment perception of their deprivation and health us to move beyond theoretically unsup- for absolute deprivation of wards. J Epidemiol ‘ ’ Community Health 2012;66:803–8. inequalities studies have compared the ported notions of absolute deprivation 3 Adjaye-Gbewonyo K, Kawachi I. Use of the Yitzhaki relative health impact of subjective versus when considering the effect of the Index as a test of relative deprivation for health objective socioeconomic circumstances.3 complex interplay of economic growth outcomes: a review of recent literature. Soc Sci Med However, because income inequality and (re)distribution11 on health. 2012;75:129–37. implies real differences in income and 4 Townsend P. Poverty in the United Kingdom. London: Penguin, 1979. living conditions WP’s theory does not Acknowledgements The author would like to thank Michaela Benzeval for helpful comments on an early 5 Townsend P. Deprivation. J Soc Policy seem to imply that these feelings of draft and to the four anonymous reviewers for their 1987;16:125–46. deprivation arise without there being helpful comments. All views expressed are the author’s 6 Whitehead M, Townsend P, Davidson N. eds. actual differences in economic resources own. Inequalities in health: the Black Report: the health divide. Penguin, 1992. or living conditions. Just that these differ- Funding FP is funded by the MRC (MC_UU_12017/7). 7 Noble M, Wright G, Smith G, et al. Measuring ences in living conditions mostly have a Provenance and peer review Not commissioned; multiple deprivation at the small-area level. Environ psychosocial meaning and impact rather externally peer reviewed. Plann A 2006;38:169–85. ‘ ’ 8 Runciman WG. Relative deprivation and social than a direct effect on health in rich To cite Popham F. J Epidemiol Community Health justice: a study of attitudes to social inequality in societies. Thus the defining difference Published Online First: [please include Day Month Year] twentieth century England. Harmondsworth: ’ doi:10.1136/jech-2013-203734 between WP s theory and materialist Penguin, 1972. theory may not be subjective versus Received 11 December 2013 9 Sen A. Poor, relatively speaking. Oxf Econ Pap objective either. Revised 27 May 2014 1983;35:153–69. There are other differences between Accepted 6 August 2014 10 Macintyre S. The Black Report and beyond what are the issues? Soc Sci Med 1997;44:723–45.
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