The fundamental causes of health inequalities are an unequal distribution in society of

  • Income - money received by individuals or groups over a specific time period.
  • Wealth  - the value of an individual or group’s money and/or material assets that have built up over time. Accumulated wealth may provide extra income from interest, rents or share dividends.
  • Power - a complex concept which includes the ability or capacity to do, or not to do, something and control, force or influence through a variety of means.  

They are fundamental because they are the basis from which health inequality is formed. 

The fundamental causes influence the distribution of wider environmental influences on health and access to services and wider society. This in turn shapes people's individual experiences and results in health inequalities.

Focusing our effort

An example of how health inequality trends follow trends in inequalities in income, wealth and power is found in the UK and USA during the 20th Century. From the early part of the 20th Century until the 1970s, income inequalities decreased at the same time as health inequalities. However, from the 1980s onwards there was a rapid increase in income inequalities and a consequent rise in health inequalities.

The ways in which fundamental causes lead to health outcomes can change over time. It is therefore more effective to influence health inequalities by reducing the inequalities in these fundamental causes. The Scottish Public Health Observatory (ScotPHO) explores this in their report ‘What would it take to eradicate health inequalities?’.

There is a growing body of evidence that shows it is only by undoing the fundamental causes that health inequality will be reduced.