Modern Studies ConferenceModern Studies Conference

Website for overheads and handouts:Website for overheads and handouts:

http://www.abdn.ac.uk/pir/hmschttp://www.abdn.ac.uk/pir/hmsc

Health & WealthHealth & Wealth

1.1. Relevance to the Higher Modern Studies Relevance to the Higher Modern Studies curriculumcurriculum

2.2. Health and wealth not separate but interdependentHealth and wealth not separate but interdependent

3.3. Contexts:Contexts: a)a) GlobalGlobal b)b) Modern economiesModern economies c)c) USAUSA d)d) UKUK e)e) ScotlandScotland

Health Data - DefinitionsHealth Data - Definitions

Mortality RateMortality Rate The The death ratedeath rate of particular social of particular social groups. It provides a measure of health risk, groups. It provides a measure of health risk, improvements in the quality of health care and the improvements in the quality of health care and the comparative overall health of a groupcomparative overall health of a group

Morbidity RateMorbidity Rate Statistics used in the analysis of Statistics used in the analysis of ill-ill-healthhealth.. They can be given in the form of either the They can be given in the form of either the number of sufferers from a particular condition or number of sufferers from a particular condition or the proportion of the overall population with that the proportion of the overall population with that conditioncondition

Source: Oxford Dictionary of SociologySource: Oxford Dictionary of Sociology

Health and Wealth- Global ContextHealth and Wealth- Global Context

In general:In general: As a society’s wealth As a society’s wealth ((Gross Gross Domestic ProductDomestic Product)) increases so does health increases so does health. . But:But:

OECD (advanced) economies:OECD (advanced) economies: Increases in Increases in these societies wealth have less effect on these societies wealth have less effect on health outcomes health outcomes (mortality and morbidity (mortality and morbidity rates)rates) than does the promotion of income than does the promotion of income equality within the societyequality within the society

Source: WilkinsonSource: Wilkinson

Health & Wealth: measuring ‘class’ and wealthHealth & Wealth: measuring ‘class’ and wealth

1.1. The welfare interest of the modern state in The welfare interest of the modern state in acquiring knowledge on citizens; acquiring knowledge on citizens; official official data gatheringdata gathering

2.2. Significance of infant mortality rates; Significance of infant mortality rates; registration of births and deathsregistration of births and deaths

3.3. USA:USA: Income measure – Income measure – cut-off problemcut-off problem

Health & Wealth - USAHealth & Wealth - USA

1.1. Federal political systemFederal political system

2.2. Health outcomes among individual states Health outcomes among individual states are heavily influenced by the degree of are heavily influenced by the degree of income equality within statesincome equality within states

3.3. Market based health provision but state Market based health provision but state provision through provision through Medicare Medicare (elderly) and (elderly) and MedicaidMedicaid (poor) is significant(poor) is significant

Health & Wealth: measuring ‘class’ and wealthHealth & Wealth: measuring ‘class’ and wealth

UK:UK: National data is typically analysed by National data is typically analysed by Occupational StatusOccupational Status, , a ‘proxy’ (stand-in) for a ‘proxy’ (stand-in) for income and social classincome and social class

Local studies sometimes use a Local studies sometimes use a deprivation deprivation indexindex applied to regions or citiesapplied to regions or cities

R-G Classification of OccupationsR-G Classification of Occupations

1.1. Professionals and Senior managementProfessionals and Senior management

2.2. Middle managementMiddle management

3.3. a)a) Routine clerical workRoutine clerical work

b)b) Skilled manual workSkilled manual work

4.4. Semi-skilled manualSemi-skilled manual

5.5. Unskilled manualUnskilled manual

Health & Wealth - UKHealth & Wealth - UK

1.1. The significance of the establishment of the The significance of the establishment of the National Health Service, 1946. Health National Health Service, 1946. Health provision provision ‘free at the point of delivery’‘free at the point of delivery’

2.2. Goal not only to improve overall health but Goal not only to improve overall health but to achieve greater equality of outcomesto achieve greater equality of outcomes

3.3. Throughout 20th century general health has Throughout 20th century general health has improved but improved but ‘class’‘class’ differences in health differences in health outcomes have widenedoutcomes have widened

Health & Wealth in UK- Black ReportHealth & Wealth in UK- Black Report

1.1. Enquiry into the effects of the NHS, published Enquiry into the effects of the NHS, published 1980, chairmanship of 1980, chairmanship of Sir Douglas BlackSir Douglas Black

2.2. Findings:Findings: General health had improved in UK General health had improved in UK since the introduction of the NHS, continuing a since the introduction of the NHS, continuing a trend from the early years of the 20trend from the early years of the 20thth century century

3.3. However, the better health outcomes of higher However, the better health outcomes of higher occupational groups as measured by occupational groups as measured by infant infant mortality rates, life expectancymortality rates, life expectancy and and inequalities in inequalities in the use of medical servicesthe use of medical services persisted and may persisted and may have increasedhave increased

Black ReportBlack Report

Evidence of increasing health inequalities Evidence of increasing health inequalities despite the NHS:despite the NHS:

Class 1Class 1 1930’s1930’s mortality rate = mortality rate = 90%90% of of national average; national average; 19721972 = = 77%77%

Class 5Class 5 1930’s1930’s mortality rate = mortality rate = 111%111% of of national average; national average; 1972 1972 = = 137%.137%.

Steady ‘gradient’ from 1-5, i.e. increasing Steady ‘gradient’ from 1-5, i.e. increasing class differencesclass differences

Health & Wealth in UK- Acheson ReportHealth & Wealth in UK- Acheson Report

1.1. Report delivered in 1998; Report delivered in 1998; Sir Donald AchesonSir Donald Acheson

2.2. ‘‘Class inequalities’ had increased further since Class inequalities’ had increased further since the Black reportthe Black report

3.3. Mortality rates among occupational groups Mortality rates among occupational groups showed persistent increase of differential showed persistent increase of differential outcomes, to the benefit of higher occupational outcomes, to the benefit of higher occupational groups, groups, even over a relatively short period of even over a relatively short period of timetime

Acheson ReportAcheson Report

1.1. In mid-1970’s: males in lower occupational In mid-1970’s: males in lower occupational groups had a death rate groups had a death rate 53%53% higher than males higher than males in class 1 & 2; 10 years later it had risen to in class 1 & 2; 10 years later it had risen to 68%68%

2.2. In mid-1970’s: females in lower occupational In mid-1970’s: females in lower occupational groups had a death rate groups had a death rate 50%50% higher than higher than females in class 1 & 2; 10 years later it had risen females in class 1 & 2; 10 years later it had risen to to 55%.55%.

3.3. If all groups had the same death rate as groups 1 If all groups had the same death rate as groups 1 & 2 over this period, there would have been & 2 over this period, there would have been 17,00017,000 fewer deaths per year in the early 1990’s fewer deaths per year in the early 1990’s

4.4. Inverse CareInverse Care and and Inverse PreventionInverse Prevention “Laws” “Laws”

Accidents aren’t RandomAccidents aren’t Random

Audit Commission Report 2007:Audit Commission Report 2007:1.1. Children of never unemployed/long term Children of never unemployed/long term

unemployed parents are:unemployed parents are: a) a) x13x13 more likely to die from more likely to die from

unintentional injury andunintentional injury andb)b) xx37 more likely to die as a result of

exposure to smoke, fire or flames than children of parents in higher managerial and professional occupations

2. In England, children in the 10 per cent most economically deprived areas are x3 more likely to be hit by a car than children in the 10 per cent least deprived areas

““Tackling Inequalities”: Dept of Health 2006Tackling Inequalities”: Dept of Health 2006

1.1. ‘‘Spearhead’Spearhead’ areas of greatest health deprivation areas of greatest health deprivation

2.2. Response to official goal to reduce class-based Response to official goal to reduce class-based health inequalities by health inequalities by 10%10% by by 20102010..

3.3. Evidence that the gap between mortality rates Evidence that the gap between mortality rates and incidence of major diseases, e.g. cardiac and incidence of major diseases, e.g. cardiac disease and cancers, of these areas and the rest disease and cancers, of these areas and the rest of society is of society is increasingincreasing..

4.4. Thus, in order to achieve the goal Thus, in order to achieve the goal trends have to trends have to be reversed.be reversed.

Health & Wealth ScotlandHealth & Wealth Scotland

Deprivation Index:Deprivation Index: crime, employment, education etccrime, employment, education etc

As deprivation of an area increases so health outcomes As deprivation of an area increases so health outcomes worsen.worsen.

InstancesInstances a)a) For both men and women death rate from For both men and women death rate from heart disease is heart disease is x2x2 in most deprived as in least in most deprived as in least deprived areasdeprived areas

b)b) Cancer rates are highest and survival Cancer rates are highest and survival rates lowest in the most deprived areas. In least rates lowest in the most deprived areas. In least deprived areas the relationship is reversed deprived areas the relationship is reversed

c)c) Self-Assessment: Self-Assessment: 61%61% of residents of least of residents of least deprived areas believed they were in good health deprived areas believed they were in good health compared to compared to 45%45% in most deprived areas in most deprived areas

Source: ISD Scotland. Source: ISD Scotland. See also the work of S. MacIntyreSee also the work of S. MacIntyre

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

PossiblePossible Explanation Explanation::

Adapting arguments of Adapting arguments of

a) a) M. WeberM. Weber

Life-chancesLife-chances how a person’s relationship to how a person’s relationship to the ownership of property and scarce skills affects the ownership of property and scarce skills affects their ability to achieve their goals such as high their ability to achieve their goals such as high quality education, good health, secure employmentquality education, good health, secure employment

Taken from: Sage Dictionary of SociologyTaken from: Sage Dictionary of Sociology

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

b) b) P. BourdieuP. Bourdieu

Life chances are affected by access to:Life chances are affected by access to:

1.1. Economic capitalEconomic capital

2.2. Social capitalSocial capital

3.3. Cultural capitalCultural capital

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

Economic capitalEconomic capital:: Resources that Resources that provide wealthprovide wealth

Relevant to distribution of e.g.Relevant to distribution of e.g.

1.1. HousingHousing warm/dry warm/dry versusversus cold/damp cold/damp

2.2. NeighbourhoodNeighbourhood play areas play areas versusversus street street

3.3. DietDiet fruit, vegetables fruit, vegetables versus versus high-fathigh-fat

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

Social Capital: Social Capital: Resources that create Resources that create social solidarity and access to social solidarity and access to valued networksvalued networks

Relevant to distribution of :Relevant to distribution of :

1.1. SupportSupport – Mutual assistance (– Mutual assistance (RosettoRosetto) ) ((GlasgowGlasgow))

2.2. TrustTrust – Encouragement to be healthy – Encouragement to be healthy ((AberdeenAberdeen))

Explaining Health & Wealth relationshipExplaining Health & Wealth relationship

Cultural Capital: Cultural Capital: Resources that give Resources that give access to valued knowledge access to valued knowledge e.g.e.g.

1.1. LanguageLanguage – Doctor - Patient interaction– Doctor - Patient interaction

2.2. EducationEducation - capacity to understand - capacity to understand health informationhealth information

The EndThe End

Good LuckGood Luck