Copyright ©2012 by Pearson Education, Inc. All rights reserved. Chapter 3 The Social Demography of...

Copyright ©2012 by Pearson Education, Inc. All rights reserved.

Chapter 3The Social Demography of Health:

Social Class

Medical SociologyTwelfth Edition

William C. Cockerham


Introduction

• In the United States, the poor face substantial barriers in life: – Typically have worse health than the affluent– Are treated within the framework of welfare

medicine– Live in disadvantaged urban and rural locales


Introduction

• Socioeconomic status or social class is the strongest and most consistent predictor of a person’s health and life expectancy across the life course regardless of access to health care or health care delivery system


The Components of Social Class

• A social class is a category or group of people who have approximately the same amount of wealth, status, and power in a society

• Different models exist:– Five-class model used in the U.S.:

• Upper class• Upper-middle class• Lower-middle class• Working class• Lower class


The Components of Social Class• Europeans tend to focus more on occupational

differences as the chief component of class position

• American sociologists usually rely on socioeconomic status (SES)– Influenced by theories of Karl Marx and Max Weber– Wealth an important component but Weber also

included social status and power – Measured by three variables:

• Income• Occupational prestige• Education



• Education appears to be the most important component of SES in predicting health outcomes

• Influences: – Knowledge about healthy lifestyles– Seeking preventive care or medical treatment for

health problems when needed – Likelihood of having better income and satisfying

jobs



• Importance of individual components of SES and their impact on health varies over the life course– Education influences the onset of chronic diseases– Income becomes more important later in life;

determines how health problems progress



• The poor have the greatest exposure to risk factors that cause ill health:– Physical (poor sanitation, poor housing)– Chemical (pollution)– Biological (bacteria, viruses)– Psychological (stress)– Economic (low income, unhealthy jobs)– Lifestyle (poor diets, smoking, lack of leisure-time

exercise)


Modern Diseases and the Poor

• Chronic diseases are most associated with modernization and were associated with upper classes– Lifestyle changes among the affluent have

reduced their risks of chronic diseases• Poor more likely to suffer from:

– Infectious diseases– Chronic diseases– Mental illness


Modern Diseases and the Poor

• Richard Wilkinson’s “income inequality hypothesis” – Blames degree of inequality among classes within

a society for health inequalities – Society’s overall level of wealth less important – Compelling argument but thus far findings in

other research have not supported his position


Equality of Care in Britain

• After World War II, socialized medicine was introduced in Great Britain

• Provides the lower classes with the same medical care available to the upper classes

• Only access to health care was equalized – social class differences unchanged


Equality of Care in Britain

• Equalization of health care alone has not reduced the disparity in health between social classes

• Black Report in 1980 sponsored by British government – Assessed trends in population health– Demonstrated health inequalities were not

decreasing among different social classes despite increased welfare services


The Social Gradient in Mortality

• Whitehall studies conducted by Marmot– Showed social class differences in mortality

among British male civil government employees– Regardless of the cause, those with the highest

occupational rank had the lowest percentage of deaths

– Mortality increased across each job category – Lowest-ranked occupations had the highest

percentage of deaths



• Social gradient observed even among relatively high ranked groups, where poverty was not an issue

• Differences in mortality were linked to hierarchy rather than deprivation

• Observed in numerous countries, regardless of the specific variable used to indicate social position



• Possible reasons for gradient include differences between classes in:– Self-esteem and stress levels– Effects of income inequality– Deprivation through life course– Health lifestyles and social support– Socioeconomic environment– Use of preventive health services


Neighborhood Disadvantage

• Five features of neighborhoods that can affect health: 1) Physical environment2) Surroundings at home, work, and play3) Services provided to support people4) Sociocultural aspects of the neighborhood5) Reputation of an area


Neighborhood Disadvantage

• Orderly neighborhoods are clean and safe, houses and buildings are well maintained, and residents are respectful of each other and each other’s property

• Disorderly neighborhoods reflect a breakdown in social order, as there is noise, litter, poorly maintained houses and buildings, vandalism, graffiti, fear, and crime


SES as a Fundamental Causeof Sickness and Mortality

• SES can be described as a direct cause of poor health because it:1) Influences multiple diseases2) Affects these diseases through multiple

pathways of risks3) Is reproduced over time4) Involves access to resources that can be used to

avoid risks or minimize the consequences of disease if it occurs


SES as a Fundamental Causeof Sickness and Mortality

• The degree of socioeconomic resources a person has or does not have, such as money, knowledge, status, power, and social connections, either protects health or causes premature mortality

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Chapter 3 The Social Demography of...

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