Health inequalitiesand social class

Week 17Sociology of Health and Illness

Recap

• Thought about how health and illness are structured by society

• Considered the ‘sick role’, medicalisation and surveillance medicine

• Looked at ‘lay’ understandings of health

Outline

• Outline the impact of social class on heath

• Consider completing explanations

• Consider how health status is individualised

Impact of Social Class

• The impact of social class on health has been debated since the mid-19th century

• The poor are sicker and die earlier than the rich

• Charities and campaignsintervene to help– Factory and Sanitation Acts, Charity Hospitals

Treatment for all?

• During the early 20th century access to medical treatment was increased

• The most significant step wasthe National Health Service Act in 1946.

• The service launched on 5 July 1948, and it was hoped that this would significantly reduce health inequalities

NHS Introduction

• http://www.nationalarchives.gov.uk/films/1945to1951/filmpage_cyvgh.htm

Did it make a difference?

• A study was to commissioned in the 1970s by the Labour Government to examine health inequalities

• The Conservative governmenttried to bury the outcome

• But the ‘Black Report’ showed the extent of class differences

Health inequalities today

• Acheson Report (1998)– Death rates have fallen but class differences

increased for all major causes of death– Premature mortality (death < 65) is higher

among people who are unskilled.

• ONS found 18.3 disability-free years between best and worse areas

• Doring found up to 10 years life expectancy difference

• Why do you think the health inequalities have persisted?

• Should we be concerned about it?

Explaining class inequalities

• The Black Report set out for main reasons why an association between poverty and health could be seen– Artefact– Health Selection– Cultural – Materialist

• Each reason leads to different actions

Artefact?

• This reason suggests that the higher level of diagnosis and death is not ‘real’

• The social processes involved in

gathering and analysing statistics contributes to the gap

• Draws on ideas about the

social construction of illness

Health Selection

• This position argues that it is not the poor that get sick, but the sick who become poor.

• Serious illness or disability oftenhas a detrimental impact on employment and income

• Highlights discrimination within social structures

Cultural or behavioural

• Ways of living differ between social classes

• Lower social classes are unhealthy• Smoking• Drinking alcohol• Poor diet• Lack of exercise

• One side sees these as individual choices, the other rooted in social circumstances

Materialist or Structural

• Poverty is the major causation– Bad housing– Lack of money – Working conditions

• Poor outcomes not just linked to behaviour

• Economic measures to reduce poverty should be main goal

Two new theories

• Since the Black Report two additional explanations have been added– Psycho-social– Life course

• Both try to explain complexity and trends in health data

Psycho-social

• Data suggests that it is not wealth per se that is important in determining health

• Wilkinson suggests it is the degree of inequality (gap between rich and poor)

• Two key concepts are– Social cohesion– Self-esteem

• Reflected in current policy on social inclusion/exclusion

Life-course

• The life-course interpretation focuses on circumstances across the lifespan

• It includes an emphasis on

maternal health

• Health is a cumulative concept which can include material and cultural factors

• Which reason(s) for health inequality do you think is most likely?

Individualising health?

• The Black Report and most other sociological studies haveargued that the strongest explanations take seriously structural factors

• Social class matters, yet both individuals and governments stress behavioural factors

Marxist explanations

• Marxism has always seen disease (and treatment) as outcomes of capitalism

• Engels argued that industrial

capitalism caused ‘Social murder’

• Health care is part of the capitalist mode of production

Marxist explanations

• Navarro argues that the organisation of healthcare– Redefines social problems as medical ones

so legitimates the status quo– The emphasis on high-tech scientific medicine

forms part of the capitalist economy– Reproduces class inequalities within the

organisation of health care and patterns of consumption

• To what extend do you think healthcare is a part of the capitalist economy?

Marxist explanations

• Redefining social problems? – Shift-work sleep disorder?

• High-tech scientific medicine– 2002 Combined Profit of Top Ten

Pharmaceutical was over US$35 billion – NHS in England spends £7 billion pa

• Reproduces class inequalities– Middle-classes become doctors– Who shouts loudest gets treated?

Summary

• Look at the evidence for an association between class and health

• Considered different explanations

• Considered Marxist views on health as a part of the capitalist economy

Next week

• Continue to consider health inequalities by focusing on gender

• Do women get sicker but men die quicker?

• Look at explanations for gendered patterns