Health and Social
Inequalities
Tackling Health
Inequalities
• This involves using interventions that
contribute to an improved health outcome
amongst groups who have disproportionately
poorer health than the rest of the population
• Occupation is used as an indicator of
inequality because it is linked to:
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Status & prestige
Income
Attitudes & lifestyle
Conditions of life
Measures used
• Individuals
– SEC scheme replaced the Registrar General’s
social class classification
• Groups
– Measures used are area based - e.g. deprivation
measures of Townsend, Jarman & IMD
• Social inequality & health has an inverse
relationship.
– Lower social class position is linked to increased
mortality (& influence of area)
Explanations for
differences:
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4.
Artefact
Health Selection
Cultural/behavioural
Materialist/social structural
1. Artefact
• Numerator-denominator basis
– Problems in coding numerator
– Denominator is the social class structure
during the decennial census
• Registrar General’s system
• Lack of reduction in inequalities
associated with a reduction in % of
population in poorest classes
2. Health Selection
• Inter-generational selection
– health status in childhood affects social mobility
and later health (indirect) or health status and
socio-economic position in early adulthood (direct)
• Intra-generational selection
– sick people drift down social hierarchy, while
healthy people move up
• But how large is this impact?
3. Cultural/Behavioural
• Shared and learned attitudes and way of life
for different social groups influence risks of ill
health
• Health is a matter of individual responsibility
and free choice (influence
attitudes/knowledge)
• Make important contributions to mortality risk
but do not adequately account for the
differences between social groups
4. Materialist/Social
Structural
• Material conditions of life lead to increased risks
of disease
• Each factor (housing, unemployment, physical &
psychological risks of work conditions, poverty)
makes a modest contribution to the total social
class gradient in health
• Differential exposure to physical hazards
determined by the distribution of income and
opportunity
• Clustering of advantage and disadvantage over
the course of life
Other Health Inequalities
• Race & Health
– Problems with definitions; in UK, linked with socioeconomic group & place
• Gender & Health
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Biological explanations
Psycho-social (personality differences)
Occupational & work related factors
Social roles & expectations
Social structural differences