Class and Health
Income and health
• Research demonstrates that wide disparities
in wealth are connected with the health of a
population.
• The greater the level of income inequity, the
poorer the population health
• Those with the lowest incomes have the worst
health outcomes, but the negative impact of
inequity is felt among all.
Poverty & Child Health
• The after-taxes poverty rate is significantly
higher in Canada (14%) than in countries such
as Sweden (3%), the Netherlands (6%), France
(7%), Germany (7%) and the United Kingdom
(10%).
• One in four children lived in poverty in 1996
compared with one in eight in 1981.
Risk factors, poverty, child health
• Living in a lone-mother family is a risk factor
for poverty.
• Children who are from visible minority groups
are at elevated risk of living in poverty.
• Aboriginal children are at increased risk of
poverty.
Inequity and child health
• Children who live in poverty encounter more hurdles to
healthy development and are, consequently, at an elevated
risk for a wide range of negative health outcomes.
• Babies born to low income parents are at an increased risk
for low birth weight.
• Males from birth to 19 years of age in the poorest quintile
had an injury death rate of 22/100,000 compared to
15/100,000 for male children in the richest quintile.
• The poorest 20% of children are at greater risk of dying in a
fire or a homicide than other children.
• Children living in households with incomes less than
$20,000 per annum are at considerably elevated risk of
“hyperactivity” and “delinquent behaviours”.
Low Income and Child Health
• Low birth weight, prematurity, low income
– Indicators of child health?
– Indicators of relationship of class and health
• Health problems of poor children begin before
birth
• Infant morality rates and distribution in social
stratification
Canada, Health, & Inequalities
Deaths of Children
• In all provinces, younger children are at greater risk of
poverty than older children.
• The national poverty rate for children under the age
of 7 climbed to 25% in 1996
– From 13% in 1981 and 21% in 1991.
• For children between the ages of 7 and 17, the
poverty rate in 1996 was 19%.
• Canada continues to have one of the highest infant
mortality rates in the developed world
• trend that has held since the 1990s
• Canada recorded five deaths for every 1,000 live
births in 2006, placing it 15th out of 17 peer
countries
Beyond Income as variable: housing
• Mortality rates among homeless and marginally
housed people were substantially higher than
rates in the poorest income groups, with the
highest rates seen at younger ages.
• higher mortality and shorter life expectancy than
could be expected on the basis of low income
alone
• the importance of considering housing situation
as a marker of socioeconomic disadvantage.
Cultural Capital & Health
Working Conditions, Class and Health
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Occupation and well-being
Top injuries: sprains and strains
Body part affected: hands and back
High risk groups: Blue collar men
Injury rates decrease when lower physical
demands
Open Class System
• facilitates mobility
• Open & closed class systems
– the extent to which mobility occurs allowing people to pass through
inequalities
• Closed system
– No mobility
– tend to persist across generations
• Open system
– ease of social mobility permitted
• individual achievement & personal merit determining social rank
• hierarchical social status is achieved on the basis of people's efforts
• ascribed status (family background, ethnicity, gender, religion, skin color) less
important
• blurred class lines & wide range of status positions
class societies
• Unequal access to all 3 advantages, economic
resources, power, prestige
– Potential for inequities
• How to define class? What variables do we
use?
– Occupation, income & wealth, prestige, education,
residence, ethnicity, gender, age, ?
Social class
• The adjective “Class” – descriptive
– collectively organized actors
– people become identified independently of kinship as a
constituent of class
– for example, biological differences or functions as defined in the
culture rather than social identities become increasingly
important
• Class formation – the formation of collectively organized
actors
• Class consciousness – the understanding of actors of their
class interests
• Class struggle – the practices of actors for the realization of
their class interests
– In contest
• Interrelationships of all these
How do we know social classes exist?
• Social stratification
• the unequal distribution of goods and services,
rights and obligations, power and prestige
• all attributes of positions in society, not attributes
of individuals
• there are significant breaks in the distribution of
goods services, rights, obligations, power prestige
• as a result of which are formed collectivities or
groups we call strata or “class”
Popular Imagination of Social Class in
Canada
•
The Upper Class
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Perhaps 3-5% of Canadians fall into this class.
Much of their wealth is inherited.
children go to private schools and they exercise great power in occupational positions.
Although this group has historically been primarily of British origin, it is now more widely distributed.
Lower-Upper Class The remaining 2-4% fall into the lower-upper class and depend more on earnings
than inherited wealth. They are, for the most part, the "nouveau riche."
The Middle Class
– 40-50% of the Canadian population
– $50,000 to $100,000 earned from upper managerial or professional fields.
– rest of the middle class (average middles) typically works in less prestigious white-collar occupations
or highly skilled blue-collar jobs
•
The Working Class
– about one-third of the population and has lower incomes than the middle class and virtually no
accumulated wealth.
•
The Lower Class
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remaining 20% of our population is identified as the lower class.
In 2001 roughly 16% of the Canadian population were labelled as poor
supported entirely by welfare payments
others are among the "working poor" whose incomes are insufficient to cover necessities like food,
shelter, and clothing.
– typically live in less desirable neighbourhoods-often racially or ethnically distinct
– children are often resigned to living the same lives of their parents.
Social Class Redefined
• Three general approaches to the conceptualization
of social class can be identified in the public health
literature:
• social class is equated with socio-economic status,
i.e., income, educational attainment and/or
occupational prestige,
• social class is a social group defined primarily by the
nature of its relationship to the economic mode of
production
• social class is a social group defined relationally in
social space by its possession and utilization of
various capitals such as economic, cultural and social
capital
Neoliberalism, Class, and Health
• Neoliberalism
– move from a bureaucratic welfare-based society
toward a meritocracy
– in the interests of business
– based on individual and economic liberty
• Health & health care consequences
– Individual centric
– Achieved health
• Class analysis and achieved status
The “Hospital” and the Imagined
communities of class
• Transformation of image and activity of
hospital
– from secular charity for indigent and working poor
– To modern workplace for the production of health
• Redefinition of the relationship of middle class
to the general public hospital
• The new economics of medical “progress”
• Changes in local health care system
Change in historical identity
• Hospital as charitable enterprise – durable disposition
• Transformation of hospital from one-class custodial care to
temple of scientific medicine for all social classes
– Safe hospitals offering professional care
– Comfort and privacy – middle class consciousness
– Metropolitan institutions
• Hospitals growing dependence on income from patients’
fees
• Transformation to “centres for the treatment of disease”
(not class; not social categories)
• But institution embedded in open class society in spite of
erasure of social class
Contemporary Hospitals
• The largest component of Canadian health care system
– Employ 2/3 of all health care workers
• Large, bureaucratized, technological complex industries
– “Health Factories”
• Transition from normative to utilitarian organizations
• Early history -- Total institutions for staff
• Social stratification – development of hospital class
system – open class system
• Classes of institutions
– Ownership groups – public (96% of bed capacity),
proprietary (profit; corp. owned), federal
– Hospitals – general, specialty, rehabilitation, extended
care, long term psychiatric
Three “castes” of hospital workers
• Occupational def., status and mobility
• Docs, technicians & nurses, non-professional
workers (dietary, laundry, housekeeping etc.)
– Labor pools in class society at large
• Indications that the social class situation in
hospital settings resemble “non-clinical areas”
(society)