POVERTY, HEALTH AND
SOCIAL EXCLUSION
What contribution can sociology
make to an understanding of
poverty and its impact on health?
INTRODUCTION
‘Inequality in health is the worst inequality of
all. There is no more serious inequality than
knowing you’ll die sooner because you’re
badly off.’
Frank Dobson, Secretary of State for
Health, 1997.
DEFINING POVERTY
‘Poverty means going short materially, socially and
emotionally. It means spending less on food, on
heating, and on clothing than someone on an
average income. Above all, poverty takes away
the tools to build the blocks for the future – your
life chances. It steals away the opportunity to
have a life unmarked by sickness, a decent
education, a secure home and a long retirement’.
Oppenheim and Harker, 1996:4.
DEFINING POVERTY
Absolute Poverty
Families are in poverty when their incomes
are ‘insufficient to obtain the minimum
necessities for the maintenance of physical
efficiency’ B.S. Rowntree, 1941.
Relative Poverty
‘Individuals, families and groups in the
population can be said to be in poverty
when they lack the resources to obtain the
types of diet, participate in the activities and
have the living conditions and amenities
which are customary, or at least widely
encouraged or approved, in the societies to
which they belong.’
Townsend, 1979.
SOCIAL EXCLUSION
Refers to the ‘dynamic process of being shut
out, fully or partially, from any of the social,
economic, political and cultural systems
which determine the social integration of a
person in society.’
Walker and Walker, 1997.
MANIFESTATIONS OF
EXCLUSION
 Social – isolated, weak or limited social
network.
 Economic – un/employment, insecure, low
paid work.
 Political – links to above re.work, not
registered to vote,no voice/disempowered.
 Cultural – little opportunity to engage in
varied range of cultural activities.
THE BLACK REPORT
 Commissioned at end of 1970s by Labour
government, chaired by Sir Douglas Black.
 To review evidence on inequalities in health
& suggest policy recommendations.
 Published in 1980 at start of Thatcher's new
Conservative administration.
 Not widely disseminated – only 260 copies
printed.
THE HEALTH DIVIDE
 Subsequent edition published by Penguin in
dual volume with Whitehead’s The Health
Divide (1987) which updated the findings,
edited by Peter Townsend and Nick
Davidson.
 This publication made the findings widely
available and made for a shocking
indictment on the state of the nation’s poor.
THE ACHESON REPORT (1998)
 An independent inquiry into inequalities in
health
 Commissioned by the Labour Government
 Access via internet: www.archive.officialdocuments.co.uk
MEASURING POVERTY
 No official poverty line in Britain
 Researchers use statistical indicators such
as benefit provision required to bring
people's income up to subsistence level
 Most commonly used threshold of low
income is 60% of median (middle) income.
Low Income Threshold
2002/3 before deducting housing costs:




Couple with no children - £194
Single person - £118
Couple with 2 children - £283
Lone parent with 2 children - £207
EXTENT OF POVERTY IN BRITAIN
 In 2002/3 12.4 million people on incomes below
this income threshold
 This represents a drop of 1.5 million since 1996/97
 In 2002/3 3.6 million children were living in
households below this income threshold
 The Black Report concluded that ‘above all, we
consider that the abolition of child poverty
should be adopted as a national goal for the
1980s.’Townsend & Davidson, 1988.
WHY ARE POOR PEOPLE POOR?
Two main explanations:
 Responsibility lies with the individual or
group – ‘blame the victim’
 Structural forces in society shape
disadvantage – ‘blame society’
BLAME THE VICTIM
 Poor people are poor because of the things
they do and the choices they make.
 Culture of poverty into which poor children
are socialised. Transmitted across
generations – people resign themselves to
their plight.
 Cycle of poverty
BLAME THE SYSTEM
 Emphasises wider social processes – political and economic factors –
that produce conditions of poverty which are difficult for individuals to
overcome.
 For example – educational opportunities, employment
patterns/opportunities.
 Class, gender and ethnicity.
 Taxation policies that benefit the better off.
 Lack of affordable childcare that reduces parent’s (especially women
and lone parents) ability to work.
POVERTY AND HEALTH
INEQUALITIES
 Social circumstances across the entire life-course
– from birth to late adulthood – influence people’s
health and well-being.
 Different socio-economic indicators – income,
wealth, educational attainment and occupational
group – are all related to and help explain people’s
health status.
 Health inequalities are produced by the clustering
of disadvantage – in opportunity, material
circumstances and behaviours related to health –
across people’s lives.
POVERTY IS BAD FOR YOUR
HEALTH
 Lack of resources (for food & shelter) can
make one vulnerable to physical illness
 Lack of control over one’s circumstances
can be psychologically damaging
 The coping strategies adopted by those on
low income may lead to behaviour that
damages health
POVERTY:THE IMPACT ON
CHILDREN’S MENTAL HEALTH
 1 in 10 children in the UK had a clinically
recognisable mental disorder in 2004 (Office for
National Statistics)
 Prevalence varied according to family
characteristics:
 More common among single-parent families
 More common in families where both parents
were unemployed
 More common among children whose parents
had no educational qualifications.
HEALTH RELATED BEHAVIOURS SMOKING
 Health-related behaviours – such as smoking and diet –
are strongly influenced by the social environment in which
people live. People do not have equal choices about
how they live their lives. (Shaw et al 1999).
Surviving by Smoking, Hilary Graham, 1994.
 ‘Smoking is one of the ways women handle and diffuse the
contradictory pressures that structure their daily lives. It
provides a way of keeping going when women have little
going for them.’
SMOKING
 ‘The habit identified as the major cause of
premature death and childhood ill-health in Britain
is – paradoxically- one which many women identify
as essential to their survival and to the survival of
their families’
 ‘Maternal smoking is a habit through which the
welfare of children is simultaneously threatened
and protected’
 Smoking can be ‘experienced as a preventive
strategy for non-accidental injury’
 Smoking has a clear ‘mood management function’
SPENDING ON TOBACCO
• ‘Like food and fuel, spending on tobacco is
inversely related to income: more is spent
proportionately on tobacco as household
income falls’
• ‘Tobacco spending has the hallmark of
necessity’
• ‘Women recognise the contradictory kind of
support that smoking provides…smoking
illuminates the toll that social divisions take on
the welfare of women and their children’.
WOMEN, POVERTY AND HEALTH
‘Women bear the brunt of poverty, it is
women who manage poverty on a daily
basis and it is women who struggle to feed,
clothe and house themselves and their
children’.
Hunt, 2004:23
The burden of ‘managing poverty’ has clear
consequences for the health status of
women.
WHY ARE WOMEN POOR?
 Multifactoral
 Women who are pregnant, women with small children,
women from ethnic minority groups and those who have
missed out on education are marginalised and excluded
(Walby, 1997)
 Lone parent families – approx 21% of all families; 90% are
mother-headed lone parent families.
 Women are more likely to be in low-paid work
 Women are more likely to have responsibility for child and
other care, reducing their capacity for employment, secure
work and promotion.
CONCLUDING THOUGHTS
Reducing health inequalities requires that
the underlying causes of these inequalities
are tackled (Shaw, et al. 1999)
SEMINAR GROUPWORK
 Who is vulnerable to poverty, and why?
 Why are poor people poor?
 What are the implications of the effects of
poverty on the role of the nurse?
RESOURCES
Blackburn, C. (1992) Poverty and Health
Shaw, M. et al (1999) The Widening Gap
http://www.nottingham.ac.uk/~lqzweb/dlp/
poverty/index.html
http:www.jrf.org.uk (Joseph Rowntree Foundation)
http://www.poverty.org.uk/intro/
www.archive.official-documents.co.uk
www.dh.gov.uk
www.statistics.gov.uk