Whose fault is it? People's own conceptions of the reasons for health inequalities

How do people themselves think about inequalities in health? The topic has rarely been investigated, and oblique evidence has to be drawn from research on general lay ideas about health and the causes of illness. Data from a large British survey are combined with a review of the extensive body of, more usually, qualitative research on attitudes to health in Western industrialised societies. One tentative conclusion is that social inequality in health is not a topic which is very prominent in lay presentations, and paradoxically this is especially true among those who are most likely to be exposed to disadvantaging environments. Possible explanations are offered in terms of the effects of widespread "health promotion" activities, and the way in which lay theorising incorporates relationships between the group and the individual. The methods used in asking people to talk about health are also relevant: accounts of health and illness are accounts of social identity, and it is unreasonable to expect people to devalue that identity by labelling their own "inequality".