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SOCIAL CLASS HEALTH INEQUALITIES
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Recap: How many can you explain? Objective & Subjective definitions of social class Registrar General Scale (RGS) NS-SEC Underclass Working class culture Means of Production Embourgeoisement Proletarianization Aristocracy & Super-Rich Ascribed/Achieved Statuses
Discuss
Why is OCCUPATION a useful measure of social class?
What are some problems with using OCCUPATION as a measure of social class? What are the problems with the NS-SEC?
Problems
The majority of the population do not have an occupation
The NS-SEC is generally based on the highest earner in a household, therefore ignores many people’s occupations.
A classification based on occupation alone ignores other factors of inequality.
Within a single occupation, there can be various levels of income, work-situation and lifestyle…
Social Class Health Inequalities: Activity
In pairs, study the graphs on the hand-out and answer the questions provided.
10 mins
Social Class & Mortality Statistics Rate of stillbirths and premature infant
deaths significantly higher for unskilled families than for professional families…
…Children from poorer families are 5 x more likely to die in an accident than those from wealthier families.
A person born into social class 1 lives (on average) about 7 years longer than someone in social class V.
Around 90% of the major causes of death are more common in social classes IV and V than in other social classes.
Studies…
The Black Report (1982) and The Health Divide (1992) show that members of the lower-classes continue to experience higher mortality rates.
These studies suggest that a considerable number of deaths could be prevented each year if all classes shared the advantages of Class I…
Social Class & Mortality Stats Working-class people go to the doctor
more often (and for a wider range of problems) than ‘professional’ people (Browne & Bottrill; 1999).
In 2001, a health self-assessment question was added into the UK Census. The 2011 results are below…
http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/local-authority-variations-in-self-assessed-general-health-for-males-and-females--england-and-wales-2011/info-self-assessed-general-health.html
Social Class & Mortality Stats Self-assessments of health tend to
worsen down the occupational hierarchy.
Full-time and self-employed people are more likely to rate their health as “good”.
Neurotic disorders are reported by 20% of unskilled manual workers, compared to 9% of professionals.
Discuss
What additional problems might there be in explaining the
relationship between health and class?
Potential Problems…
Extraneous variables (“class” is an umbrella term that incorporates a range of variables e.g. diet, geographical location, ethnicity, gender etc.)
Classes are changing – difficult to establish patterns of health as classes change
Onset of disease is delayed – Some diseases appear years after exposure to them, making it difficult to establish patterns.
Consider the different types of explanation. For each, decide on at least two explanations as to why people from lower social class backgrounds experience worse health and lower life expectancies:
ARTEFACTCULTURAL/BEHAVIOURALSTRUCTURAL/MATERIAL
In Pairs
Artefact Explanations
Researchers often focus on the differences between the highest and lowest classes. These are the extremes, ignoring everything in between…
Artefact Explanations suggest that social class health inequalities are not real; they are just a product of statistics…
…There is no convincing support for this view. Almost all researchers agree that class differences in health are both real and serious.
Social Selection Explanations
Class does not effect health as much as Health effects class…
…People with poor health fail to get good qualifications and/or good jobs and therefore are concentrated in the lower classes
Discuss (Pairs):
List five ways in which people become upwardly mobile (e.g. improve on the position they were born into)?
For each, explain how ill health could prevent this happening fully.
Social Selection Explanations Wealthier classes appear statistically
healthier because healthy people are more likely to become wealthy…
…Lower classes appear statistically less healthy because unhealthy people of all classes end up in the lower classes…
So health influences the direction in which people move up or down the
social scale.
Evidence in support of social selection
Wadsworth (1995) claimed that boys who experience serious childhood illnesses are more likely to be downwardly mobile by age 26.
Connelly & Crown (1994) claimed that schizophrenia is over-represented among homeless people because developing the illness puts a person at risk of homelessness.
Activity
Complete the social selection activity on the worksheet provided.
Issues with Social Selection Explanations
Illness does not always lead to downward mobility. Some people adapt to illness and continue with their careers…
…Likewise, good health does not guarantee upward mobility. Appropriate qualifications and experience are much more important.
Cultural Explanations
Inequalities in health are the result of differences in norms, values, attitudes, lifestyle and behaviour between social classes.
RECAP:
What are the features of working class culture according to Willis (1977)?
Could any of these lead to ill health?
Why might the lifestyles of upper class people ensure they are healthier?
Cultural Explanations
Annandale & Field (2007) claimed that working-class people have more negative definitions of health. They also have lower expectations of health, considering it in fatalistic terms. This can impact their health behaviours…
Pairs: Identify a minimum of FIVE behaviours which might increase one’s risk
of illness or premature death…
Studies tend to conclude that working-class people…
Smoke More…
Drink More…
Eat less well…
Exercise less…
From Cancer Research UK:
Cultural Explanations
“Much ill health in Britain today arises from over-indulgence and unwise
behaviour. Not surprisingly, the greatest potential and perhaps the greatest
problem for preventative medicine now lies in changing behaviour and attitudes to
health…”(The Labour Party – Prevention & Health -
1977)
Problems with Cultural Explanations
Accused of blaming the victim (e.g. if the lower classes suffer worse health, it’s their own fault…)
Townsend (1999) points out that some people have more freedom to ‘choose’ a healthy lifestyle than others. Poorer people adopt unhealthy behaviours as a response to their situation…
Blackburn (1991) claims that improving the income for poorer families will improve their eating patterns…
Structural/Material Explanations
Social class inequalities are caused by the structure of society and people’s different living/working conditions.
Argue that some factors which appear to be cultural are actually due to other factors. For example, poor diets among the working classes is down to low income, not personal choice.
Discuss:
How could the following material factors lead to ill-health?
Long working hours? Dangerous working environment? Damp housing? Low income/unemployment? Stress?
Ext: - Suggest one solution to each of the above!
Structural/Material Explanations
Accident rates are higher amongst those in manual labour.
Those who live in poorer housing have higher rates of respiratory diseases (Martin et al, 1987)
The material effects of unemployment are significant, leading to stress, disruption and behavioural patterns that damage health (Morris et al, 1994)
Lobstein (1995) found that healthy food cost less in affluent parts of London than it did in poorer areas.
THE WHITEHALL STUDY (Marmot) Asked why lower grade civil servants had
higher rates of death from all causes and specifically coronary heart disease
Even when controlling for factors such as smoking, obesity, leisure time, height etc. the lower grades still had a risk factor of 2:1 compared to highest grade.
Concluded stress associated with lack of control was a significant factor.
http://www.abc.net.au/science/slab/stress/whithall.htm
A Sociology Exam in which you have to answer four essay questions in ninety minutes, following a precise structure for each question.
A Sociology Exam in which you answer four unstructured essay questions from a choice of twelve in up to four hours.
Discuss: Which would you prefer and why?
How does this relate to the Whitehall Study?
Do you agree that people of a lower social class are likely to have less control over their own work?
Do you agree that this leads to stress?
Are there any other factors that might mean people from the lower social classes experience more stress (and therefore more ill health in general)?
Discuss
An Unhealthy Environment
YouTube - Health Inequalities - Social Determinants of Health Film (Glasgow)
Individually, while watching: Identify and explain the potential factors
impacting health in this short film…
Compare your responses to those of a partner.
Multiple Disadvantage
Multiple disadvant
age
Inverse Care Law (Hart,1971)
Care is distributed in inverse proportion to need Deprived areas have fewer GPs People on low incomes are more likely to be
dependent on public transport for getting to a surgery or hospital
People in manual work are more likely to lose pay if they take time off work
Poorly educated people are less likely to be knowledgeable about health and health services and to be assertive when dealing with doctors
Do not have the money to jump NHS waiting lists by using private services
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Social Class & Mental Health
Class & Mental Health
Rogers & Pilgrim (2005) agreed that poorer people are significantly more likely to experience mental health problems.Stansfield et al (2003) found that work is the main factor in depressive symptoms in men: Both lack of employment and inadequate employment.Ross et al (2001) believed that bad neighbourhoods were a key influence on mental health.Reading & Reynolds (2001) found that anxiety about debt was the best predictor of depressive symptoms in families.
Match these studies to explanations/studies already covered in this section:
Homework
Identify and Explain TWO types of explanation for Social Class
Inequalities [17]
Due: Next Lesson
