SOCIAL CLASS HEALTH
INEQUALITIES
G672
Recap: How many can you explain?
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Objective & Subjective definitions of social class
Registrar General Scale (RGS)
NS-SEC
Underclass
Working class culture
Means of Production
Embourgeoisement
Proletarianization
Aristocracy & Super-Rich
Ascribed/Achieved Statuses
Discuss
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Why is OCCUPATION a useful measure of social
class?
What are some problems with using OCCUPATION
as a measure of social class? What are the
problems with the NS-SEC?
Problems
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The majority of the population do not have an
occupation
The NS-SEC is generally based on the highest
earner in a household, therefore ignores many
people’s occupations.
A classification based on occupation alone ignores
other factors of inequality.
Within a single occupation, there can be various
levels of income, work-situation and lifestyle…
Social Class Health Inequalities:
Activity
In pairs, study the graphs on the hand-out and answer
the questions provided.
10 mins
Social Class & Mortality Statistics
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Rate of stillbirths and premature infant deaths
significantly higher for unskilled families than for
professional families…
…Children from poorer families are 5 x more likely to
die in an accident than those from wealthier families.
A person born into social class 1 lives (on average)
about 7 years longer than someone in social class
V.
Around 90% of the major causes of death are more
common in social classes IV and V than in other social
classes.
Studies…
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The Black Report (1982) and The Health Divide
(1992) show that members of the lower-classes
continue to experience higher mortality rates.
These studies suggest that a considerable number
of deaths could be prevented each year if all
classes shared the advantages of Class I…
Social Class & Mortality Stats
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Working-class people go to the doctor more often (and
for a wider range of problems) than ‘professional’
people (Browne & Bottrill; 1999).
In 2001, a health self-assessment question was added
into the UK Census. The 2011 results are below…
http://www.ons.gov.uk/ons/rel/census/2011-censusanalysis/local-authority-variations-in-self-assessedgeneral-health-for-males-and-females--england-andwales-2011/info-self-assessed-general-health.html
Social Class & Mortality Stats
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Self-assessments of health tend to worsen down the
occupational hierarchy.
Full-time and self-employed people are more likely
to rate their health as “good”.
Neurotic disorders are reported by 20% of
unskilled manual workers, compared to 9% of
professionals.
Discuss
What additional problems might there be in
explaining the relationship between health and
class?
Potential Problems…
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Extraneous variables (“class” is an umbrella term
that incorporates a range of variables e.g. diet,
geographical location, ethnicity, gender etc.)
Classes are changing – difficult to establish patterns
of health as classes change
Onset of disease is delayed – Some diseases
appear years after exposure to them, making it
difficult to establish patterns.
In Pairs
Consider the different types of explanation. For
each, decide on at least two explanations as to why
people from lower social class backgrounds
experience worse health and lower life
expectancies:
ARTEFACT
CULTURAL/BEHAVIOURAL
STRUCTURAL/MATERIAL
Artefact Explanations
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Researchers often focus on the differences between
the highest and lowest classes. These are the
extremes, ignoring everything in between…
Artefact Explanations suggest that social class
health inequalities are not real; they are just a
product of statistics…
…There is no convincing support for this view.
Almost all researchers agree that class
differences in health are both real and serious.
Social Selection Explanations
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Class does not effect health as much as Health
effects class…
…People with poor health fail to get good qualifications
and/or good jobs and therefore are concentrated in the
lower classes
Discuss (Pairs):
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List five ways in which people become upwardly
mobile (e.g. improve on the position they were born
into)?
For each, explain how ill health could prevent this
happening fully.
Social Selection Explanations
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Wealthier classes appear statistically healthier
because healthy people are more likely to become
wealthy…
…Lower classes appear statistically less healthy
because unhealthy people of all classes end up in
the lower classes…
So health influences the direction in which people
move up or down the social scale.
Evidence in support of social
selection
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Wadsworth (1995) claimed that boys who
experience serious childhood illnesses are more
likely to be downwardly mobile by age 26.
Connelly & Crown (1994) claimed that
schizophrenia is over-represented among homeless
people because developing the illness puts a person
at risk of homelessness.
Activity
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Complete the social selection activity on the
worksheet provided.
Issues with Social Selection
Explanations
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Illness does not always lead to downward mobility.
Some people adapt to illness and continue with
their careers…
…Likewise, good health does not guarantee
upward mobility. Appropriate qualifications and
experience are much more important.
Cultural Explanations
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Inequalities in health are the result of differences in
norms, values, attitudes, lifestyle and behaviour
between social classes.
RECAP:
What are the features of working class culture
according to Willis (1977)?
Could any of these lead to ill health?
Why might the lifestyles of upper class people
ensure they are healthier?
Cultural Explanations
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Annandale & Field (2007) claimed that workingclass people have more negative definitions of
health. They also have lower expectations of
health, considering it in fatalistic terms. This can
impact their health behaviours…
Pairs: Identify a minimum of FIVE behaviours
which might increase one’s risk of illness or
premature death…
Studies tend to conclude that
working-class people…
Smoke More…
Drink More…
Eat less well…
Exercise less…
From Cancer Research UK:
Cultural Explanations
“Much ill health in Britain today arises from overindulgence and unwise behaviour. Not surprisingly, the
greatest potential and perhaps the greatest problem for
preventative medicine now lies in changing behaviour
and attitudes to health…”
(The Labour Party – Prevention & Health - 1977)
Problems with Cultural Explanations
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Accused of blaming the victim (e.g. if the lower classes
suffer worse health, it’s their own fault…)
Townsend (1999) points out that some people have
more freedom to ‘choose’ a healthy lifestyle than
others. Poorer people adopt unhealthy behaviours as a
response to their situation…
Blackburn (1991) claims that improving the income for
poorer families will improve their eating patterns…
Structural/Material Explanations
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Social class inequalities are caused by the structure
of society and people’s different living/working
conditions.
Argue that some factors which appear to be
cultural are actually due to other factors. For
example, poor diets among the working classes is
down to low income, not personal choice.
Discuss:
How could the following material factors lead to ill-health?
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Long working hours?
Dangerous working environment?
Damp housing?
Low income/unemployment?
Stress?
Ext: - Suggest one solution to each of the above!
Structural/Material Explanations
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Accident rates are higher amongst those in manual
labour.
Those who live in poorer housing have higher rates of
respiratory diseases (Martin et al, 1987)
The material effects of unemployment are significant,
leading to stress, disruption and behavioural patterns
that damage health (Morris et al, 1994)
Lobstein (1995) found that healthy food cost less in
affluent parts of London than it did in poorer areas.
THE WHITEHALL STUDY (Marmot)
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Asked why lower grade civil servants had higher rates
of death from all causes and specifically coronary
heart disease
Even when controlling for factors such as smoking,
obesity, leisure time, height etc. the lower grades still
had a risk factor of 2:1 compared to highest grade.
Concluded stress associated with lack of control was a
significant factor.
http://www.abc.net.au/science/slab/stress/whithall.htm
Discuss: Which would you prefer and
why?
A Sociology Exam in which you have to answer
four essay questions in ninety minutes, following a
precise structure for each question.
A Sociology Exam in which you answer four
unstructured essay questions from a choice of twelve
in up to four hours.
How does this relate to the
Whitehall Study?
Discuss
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Do you agree that people of a lower social class
are likely to have less control over their own work?
Do you agree that this leads to stress?
Are there any other factors that might mean people
from the lower social classes experience more stress
(and therefore more ill health in general)?
An Unhealthy Environment
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YouTube - Health Inequalities - Social Determinants
of Health Film (Glasgow)
Individually, while watching: Identify and explain
the potential factors impacting health in this short
film…
Compare your responses to those of a partner.
Multiple Disadvantage
Unemployment
and low pay
Poor
education
Inadequate
housing
Multiple
disadvantage
Poor
environment
Poor health
High levels
of crime
Inverse Care Law (Hart,1971)
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Care is distributed in inverse proportion to need
Deprived areas have fewer GPs
 People on low incomes are more likely to be dependent on
public transport for getting to a surgery or hospital
 People in manual work are more likely to lose pay if they
take time off work
 Poorly educated people are less likely to be knowledgeable
about health and health services and to be assertive when
dealing with doctors
 Do not have the money to jump NHS waiting lists by using
private services
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Social Class & Mental Health
G672
Class & Mental Health
Rogers & Pilgrim (2005) agreed that poorer people are
significantly more likely to experience mental health
problems.
Stansfield et al (2003) found that work is the main factor
in depressive symptoms in men: Both lack of employment
and inadequate employment.
Ross et al (2001) believed that bad neighbourhoods
were a key influence on mental health.
Reading & Reynolds (2001) found that anxiety about
debt was the best predictor of depressive symptoms in
families.
Homework
Identify and Explain TWO types of explanation for
Social Class Inequalities [17]
Due: Next Lesson