SOCIAL CLASS & OTHER
INEQUALITIES IN
HEALTH
Kai-Lit Phua,PhD FLMI
Associate Professor
School of Medicine & Health
Sciences
Monash University Malaysia
Biographical Details
Kai-Lit Phua received his BA (cum laude) in Public Health
& Population Studies from the University of Rochester
and his PhD in Sociology (Medical Sociology)from Johns
Hopkins University. He also holds professional
qualifications from the insurance industry.
Prior to joining academia, he worked as a research
statistician for the Maryland Department of Health and
Mental Hygiene and for the Managed Care Department
of a leading insurance company in Singapore.
He was awarded an Asian Public Intellectual Senior
Fellowship by the Nippon Foundation in 2003.
EPIDEMIOLOGY
Study of the determinants (“causes”) and
distribution of disease in human populations.
Epidemiologists look for possible relationships
between disease and these factors:






Social Class (“Class”)
Ethnicity (“Race”)
Gender (“Sex”)
Age
Region e.g. urban, suburban, rural
e.g. low income country, middle income
country, high income country
Other e.g. education, “illegal worker” status
UNEQUAL DISTRIBUTION OF
DISEASE
Ethnicity: In Malaysia, Orang Asli have the worst
health e.g. malnutrition is more common, they
experience more disability and higher rates of
disease, and they die younger
 Gender: Males are at higher risk of dying from
certain health conditions. Females are at higher
risk for other health conditions.
 Age: Young children and old people
 Region: Rural people generally have poorer
health than urban people. In the cities, slum
dwellers have poorer health than non-slum
dwellers.

DISTRIBUTION OF DISEASES
ARE AFFECTED BY
SOCIOECONOMIC FACTORS
Other socioeconomic factors:


Education: Better educated people tend to
have better health
Illegal workers: They are at higher risk of
developing occupational-related diseases
UNEQUAL ACCESS TO HEALTH
SERVICES
Julian Tudor Hart’s “Inverse Care Law”:
People who need health services the most are the
least likely to get them
Why? Because of barriers to access:
 Financial barriers e.g. unable to pay, cannot
afford to take time off from work to see the
doctor
 Geographic barriers e.g. too far to travel
 Cultural barriers
SOCIAL CLASS IS A VERY
IMPORTANT FACTOR RELATED
TO HEALTH
A person’s “social class” position is strongly
linked to his or her health status.
Social Class is measured either by a person’s
INCOME or OCCUPATION
Social Class Groupings:
Upper Class, Middle Class, Working Class,
Underclass
THE SOCIAL CLASS GRADIENT
IN HEALTH
People from lower social classes usually
experience higher disability rates, higher
morbidity rates, higher mortality rates and have
lower life expectancy (than people from the
upper classes)
Thus,
“The lower the social class, the lower the health
status of people”
THE SOCIAL CLASS GRADIENT
IN HEALTH
It is NOT a statistical artifact:
No matter how “social class” is measured,
the relationship between low social class
and low health status is found in every
country where health statistics are
collected
REASONS FOR THE SOCIAL
CLASS GRADIENT IN CLASS
1)
Poverty e.g. not enough money to buy proper
food, being forced to live in poor quality
housing in unhealthy or high crime areas
2) Lower class people are less well-educated and
have less knowledge of healthy lifestyles
3) Class differences in health-related behaviour
4) More dangerous jobs of lower class people
5) More stressful lives of lower class people
SOCIAL CLASS AND HEALTH
A low social class position can have a
negative effect on health
But, poor health can also lead to a fall in
social class position (the “Downward Drift”
hypothesis) e.g. people who become
alcoholics or drug addicts, people who
cannot work because of bad health etc
can fall into poverty
CAN EQUAL ACCESS TO
MEDICAL SERVICES ELIMINATE
THE SOCIAL CLASS GRADIENT?
In 1947-48, the British Government established
the NHS (National Health Service) and made
access to medical services equal for all social
classes.
However, the social class gradient continues to
persist in Britain (documented by the “Black
Report”)
 Thus, we conclude that good health depends on
more than just access to medical services
THE END
THANK YOU