Artefact explanations of inequalities in health: an assessment of the evidence

Abstract

Artefact explanations seek to account for inequalities in health as a construct of the measurement process. The Black Report believed that the artefact explanation was relatively unimportant in accounting for the persistence of class inequalities in health. This paper reviews the evidence on artefact explanations of class differentials in specific-cause and all-cause mortality data, and also of differentials by occupation, by geography, and by gender. It is concluded that the role of artefact explanations in mortality differentials is larger, more pervasive, and more complex than Black and his colleagues believed.