Black Report

An influential Report of the Working Group on Inequalities in Health (under the chairmanship of Sir Douglas Black) submitted to the British Government in 1980. The Report synthesized much evidence, hitherto available mainly in academic journals and in a fragmented form, which suggested that Britain's health service was failing to reduce social (particularly class ) inequalities in health.

For example, the Report argued that working-class men and women are significantly more likely than are those in the managerial or professional classes to die early, and that children born into working-class homes are exposed to higher risks of early mortality, illness, and injury than are those coming from middle-class backgrounds. More controversially, it suggested that although many absolute improvements in the various rates had been achieved over time, some class differentials in health outcomes had actually increased over the period of thirty years or so since the National Health Service was first established. It argued that this was due, not so much to the flawed workings of the health-care system itself, or to restricted access to health-care facilities, as to social inequalities such as those to be found in housing and working conditions, in the distribution of incomes, and in opportunities for educational advancement. The authors of the Report concluded that health standards could only be improved and equalized by major initiatives in community health, preventive medicine, and primary care, and (more importantly) by radical shifts in social policy in order to improve the standard of living of the working classes.

Notoriously, the Conservative administration which received the Report made strenuous efforts to suppress it, although these simply created intense media interest. When the findings were finally published (see, Inequalities in Health, 1982) they became the focus for a protracted debate among epidemiologists, sociologists, and public health experts. On the one hand, the Report stimulated further research into class and other persisting social inequalities in health, including comparative studies which examined Britain in relation to industrialized societies elsewhere. On the other, critics suggested that the Report's tendency to focus upon mortality (death) rates overlooked the complexities of the relationship between these and morbidity (sickness) rates, in particular the possibility that inequalities in death-rates may have only a weak relationship to inequalities in health. (For example, mental illness rarely results in death, but has a significant although complex relationship to social class.)

Whatever the weaknesses of the Report, it was important in promoting interest in the sociology of health and illness , and provides a good illustration of the way in which sociologists can inform social policy by means of policy research . In the longer term, its greatest sociological significance may lie in the fact that it acted as a catalyst for a vigorous discussion of the methodological problems involved in epidemiological work, including those associated with the use of the Registrar-General's (that is the British Government's official) occupational classification as a measure of social class (some commentators argued that the Report actually underestimated class differentials in health because of the class heterogeneity of some of the Registrar-General's categories); the implications of social mobility for health (is poor health more common among the working classes and the poor because sick people are likely to be steadily downwardly mobile?); and the difficulties of interpreting complex causal interactions between differences in life-style (smoking, diet, leisure activities, and the like) and effects attributable to social class as such.

A useful discussion of some of the issues that have emerged as a result of the debate prompted by Black will be found in, ‘Explaining Health Inequalities: Beyond Black and Barker’, European Sociological Review (1995). As a measure of how much more sophisticated that debate has now become, the original Report can usefully be compared with recent studies such as that by, ‘Measuring Inequalities in Health’ (Sociology of Health and Illness, 1996), which examines trends in mortality in Britain in terms both of the conventional Registrar-General's class categories and the newer and more robust Goldthorpe class scheme.