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230 THE ISA HANDBOOK IN CONTEMPORARY SOCIOLOGY

(World Bank, 2005a, Table A3). Generally, the least developed countries and it tends to
there is a decline in the infant mortality rate shrink with a rise in per capita income. This
with the decline in inequality. However, the implies that economic development does
gradient differs widely by country. The gra- help to reduce the gap between the rich and
dient is steepest in India, followed by that in the poor at least in terms of getting children
Peru, Egypt, Bangladesh, and Uganda. It is immunized.
not as steep in Nepal, Zambia, Zimbabwe, According to some research, it is poverty
and Colombia, while it is somewhat curvilin- and not economic inequality that is responsi-
ear in Ethiopia and sporadic in Mali and ble for high mortality in less developed
Tanzania. In sum, there is no systematic countries. Inequality is usually to the disad-
pattern of relationship between the gradient vantage of the poor and therefore it is likely
and the countries’ levels of economic devel- to result in high overall mortality in countries
opment and economic inequality, implying where the poor form a large segment of the
that other factors must explain this variability. population. As Deaton (2003: 115) argues,
It is well known that these global aggre- ‘individuals are more likely to be sick or to
gate statistics can obscure large disparities die if they live in places or in periods where
between and within nations, particularly income inequality is higher. The raw correla-
when they are not examined in a multivariate tions that exist in (some of the) data are
manner. However, they are not completely most likely the result of factors other than
out of line with various in-depth analyses income inequality, some of which is ulti-
(Braveman and Tarimo, 2002). By analyzing mately linked to broader notions of inequal-
access to health care, prevalence of specific ity or unfairness’ rather than income
diseases, and mortality patterns for about 100 inequality per se. This hypothesis has
districts and counties in China, Zhao (2006) received support in a number of recent stud-
found that growing economic inequality ies (Deaton, 2003; Gravelle et al., 2002;
impeded progress in mortality decline in Lynch et al., 2004; Mackenbach, 2002;
poor areas and among disadvantaged social Wagstaff and Doorslaer, 2000).
groups despite globalization and impressive To some scholars, the socioeconomic gra-
overall economic growth over the last dient in mortality in a country is a reflection
25 years. By analyzing child mortality data of conditions which are difficult to gauge by
in 11 countries in sub-Saharan Africa, objective measures such as per capita
Brockerhoff and Hewett (2000) found that by income, Gini index, and so on. Wilkinson
and large ethnic mortality differences were (1996), a most well-known advocate of the
linked to economic inequality and differential ‘inequality–mortality’ hypothesis, finds that
use of child health services. income inequality, like air pollution or toxic
A major reason for socioeconomic dispar- radiation, is itself a health hazard. Some
ity in mortality is differential access to health scholars (Daniels et al., 1999; Sapolsky,
care facilities by social class. Studies show 2005a, 2005b) argue, it is not just the lack of
that mothers from lower socioeconomic absolute deprivation associated with low eco-
backgrounds are less familiar with basic nomic development (such as the lack of
health care practices and are less likely to access to basic material conditions necessary
visit health personnel or hospitals (Caldwell, for health such as clean water, adequate
1986b). Also, children from lower socioeco- nutrition and housing, and general sanitary
nomic backgrounds are less likely to receive living conditions) that explains health and
vaccinations. In almost every less developed mortality differences between and within
country for which reliable data are available, countries, but rather a ‘lack of sources of
the immunization rate is higher among the self-respect that are deemed essential for full
rich than among the poor (World Bank, participation in society’ (Daniels et al., 1999:
2005b, Table 2.6). The gap is much wider in 221). They argue further that ‘feeling poor