Health inequalities
and social class
Week 17
Sociology of Health and Illness
Recap
• Thought about how health and illness are
structured by society
• Considered the ‘sick role’, medicalisation
and surveillance medicine
• Looked at ‘lay’ understandings of health
Outline
• Outline the impact of social class on heath
• Consider completing explanations
• Consider how health status is
individualised
Impact of Social Class
• The impact of social class on health has
been debated since the mid-19th century
• The poor are sicker and die earlier than
the rich
• Charities and campaigns
intervene to help
– Factory and Sanitation Acts, Charity Hospitals
Treatment for all?
• During the early 20th century access to
medical treatment was increased
• The most significant step was
the National Health Service Act in 1946.
• The service launched on 5 July 1948, and
it was hoped that this would significantly
reduce health inequalities
NHS Introduction
• http://www.nationalarchives.gov.uk/films/1
945to1951/filmpage_cyvgh.htm
Did it make a difference?
• A study was to commissioned in the 1970s
by the Labour Government to examine
health inequalities
• The Conservative government
tried to bury the outcome
• But the ‘Black Report’ showed the extent
of class differences
Health inequalities today
• Acheson Report (1998)
– Death rates have fallen but class differences
increased for all major causes of death
– Premature mortality (death < 65) is higher
among people who are unskilled.
• ONS found 18.3 disability-free years
between best and worse areas
• Doring found up to 10 years life
expectancy difference
• Why do you think the health inequalities
have persisted?
• Should we be concerned about it?
Explaining class inequalities
• The Black Report set out for main reasons
why an association between poverty and
health could be seen
– Artefact
– Health Selection
– Cultural
– Materialist
• Each reason leads to different actions
Artefact?
• This reason suggests that the higher level
of diagnosis and death is not ‘real’
• The social processes involved in
gathering and analysing statistics
contributes to the gap
• Draws on ideas about the social
construction of illness
Health Selection
• This position argues that it is not the poor
that get sick, but the sick who become
poor.
• Serious illness or disability often
has a detrimental impact on employment
and income
• Highlights discrimination within social
structures
Cultural or behavioural
• Ways of living differ between social
classes
• Lower social classes are unhealthy
•
•
•
•
Smoking
Drinking alcohol
Poor diet
Lack of exercise
• One side sees these as individual choices,
the other rooted in social circumstances
Materialist or Structural
• Poverty is the major causation
– Bad housing
– Lack of money
– Working conditions
• Poor outcomes not just linked to behaviour
• Economic measures to reduce poverty
should be main goal
Two new theories
• Since the Black Report two additional
explanations have been added
– Psycho-social
– Life course
• Both try to explain complexity and trends
in health data
Psycho-social
• Data suggests that it is not wealth per se
that is important in determining health
• Wilkinson suggests it is the degree of
inequality (gap between rich and poor)
• Two key concepts are
– Social cohesion
– Self-esteem
• Reflected in current policy on
social inclusion/exclusion
Life-course
• The life-course interpretation focuses on
circumstances across the lifespan
• It includes an emphasis on
maternal health
• Health is a cumulative concept which can
include material and cultural factors
• Which reason(s) for health inequality do
you think is most likely?
Individualising health?
• The Black Report and most other
sociological studies have
argued that the strongest
explanations take seriously
structural factors
• Social class matters, yet both individuals
and governments stress behavioural
factors
Marxist explanations
• Marxism has always seen disease (and
treatment) as outcomes of capitalism
• Engels argued that industrial
capitalism caused ‘Social murder’
• Health care is part of the capitalist mode of
production
Marxist explanations
• Navarro argues that the organisation of
healthcare
– Redefines social problems as medical ones
so legitimates the status quo
– The emphasis on high-tech scientific medicine
forms part of the capitalist economy
– Reproduces class inequalities within the
organisation of health care and patterns of
consumption
• To what extend do you think healthcare is
a part of the capitalist economy?
Marxist explanations
• Redefining social problems?
– Shift-work sleep disorder?
• High-tech scientific medicine
– 2002 Combined Profit of Top Ten
Pharmaceutical was over US$35 billion
– NHS in England spends £7 billion pa
• Reproduces class inequalities
– Middle-classes become doctors
– Who shouts loudest gets treated?
Summary
• Look at the evidence for an association
between class and health
• Considered different explanations
• Considered Marxist views on health as a
part of the capitalist economy
Next week
• Continue to consider health inequalities by
focusing on gender
• Do women get sicker but men die quicker?
• Look at explanations for gendered
patterns