Health inequalities
Joan Garrod
Health inequalities
Definition
The World Health Organization (WHO) defines health inequalities as
follows:
‘The differences in health status or in the distribution of health
determinants between different population groups.’
Health inequalities
Relevant groups in the UK
In the UK, the population groups showing differences in health and
health chances are based on:
Social class
Gender
Ethnicity
Region
These are not, of course, mutually exclusive — e.g. working-class
people tend to live in more deprived areas.
Health inequalities
Factors determining health
So, what factors determine our actual health and our health
chances? The WHO Commission on the Social Determinants of
Health (2008) took a holistic view. Their report said that health
inequalities both within and between countries are caused by:
• The unequal distribution of power, income, goods and services
which in turn leads to unfairness in people’s lives — namely:
• Their access to health care, schools and education
• Their conditions of work and leisure
• Their homes, communities, towns or cities
• Their chances of leading a flourishing life
Health inequalities
Factors determining health
The Royal College of Nursing (Policy Briefing January 2012)
summarises by saying that the social determinants of health are:
‘The collective set of conditions in which people are born, grow up,
live and work.’
• Some health conditions are the result of biology (e.g. inherited
genetic diseases) or lifestyle (e.g. smoking, excessive drinking).
• Other health inequalities are beyond the control of individuals and
groups, and could be avoided, and it is these on which sociologists
and others have focused.
Health inequalities
Models explaining social class
inequalities in health (1)
Behavioural model: this suggests that the causes are health-damaging
or health-promoting behaviours, such as diet, drugs and alcohol
consumption. However, long-term studies have found that
differences in health behaviour explain only one-third of social class
differences in mortality.
Materialist model: poverty exposes people to greater health hazards,
e.g. poor housing, air pollution, insufficient or unhealthy food.
Health inequalities
Models explaining social class
inequalities in health (2)
Psycho-social model: the effects of social inequality may cause stress
which can bring about biological changes that increase the risk of
heart disease. Evidence shows that people who have good
relationships with family and friends and participate in the
community have longer life expectancy than those who are
isolated. Poverty can result in both stress and isolation.
Life-course model: health reflects the patterns of all advantages and
disadvantages experienced by a person over the course of their life.
Disadvantages or advantages at birth and during early childhood
are likely to extend into adulthood.
Health inequalities
Social class
The average life expectancy for women is higher than that for men in
all social class groups. But, with each downward grade of a social
class (whichever measure of social class is used), average life
expectancy for both men and women decreases.
Men in the top social class can expect to live, on average, 7 years
longer than men in the bottom social class, and the gap is similar
for women.
Discussion point: What social factors can you think of to explain this
pattern?
Health inequalities
Life expectancy at birth for men and women by social class
England and Wales 2002–5
Source: Office for National Statistics 2007, licensed under the Open Government License v3.0.
Health inequalities
Region
(Remember that region/area is closely linked to social class.)
Statistics showing some UK regional patterns of health inequalities:
In England, the average difference in ‘disability-free’ life expectancy between
the poorest and richest areas is 17 years. (ONS 2009 Life Expectancy at Birth)
In Scotland, men living in the most deprived areas will die, on average, almost
11 years earlier than those living in the least deprived areas. (NHS Healthy
Life Expectancy in Scotland December 2011)
In Northern Ireland, men living in the poorest areas will die on average 8
years earlier than men living in the wealthiest areas. (Northern Ireland Health
and Social Care Monitoring System 2013)
In England, primary school children from deprived areas are twice as likely to
be obese as those from wealthier areas. (HSCIC National Child Measurement
Programme December 2014)
Health inequalities
Ethnicity
Health inequalities are also seen among different ethnic groups:
•
The White Gypsy or Irish Traveller groups, identified for the first time in the
2011 Census, have particularly poor health. Both men and women have
twice the White British rates of limiting long-term illness.
•
50% of all men aged 65 or older reported a limiting long-term illness, but
69% of Bangladeshi older men reported being ill.
•
56% of all women aged 65 or older reported a limiting long-term illness, but
this was reported by 70% of Pakistani and Bangladeshi women.
•
Conversely, the Chinese group reported consistently better health: half or
under half the White British rate for both men and women.
(‘Ethnic Health Inequalities 1991–2011’, ESRC Centre on Dynamics of Ethnicity, October 2013)
Question: What reasons can you suggest for these differences? (Think of social
class, area and cultural differences.)
Health inequalities
Gender
In industrialised countries, women on average live longer than men, but appear
to experience more ill-health. Men have higher mortality rates for the more
common causes of death such as heart disease and lung cancer, but women
report higher incidences of complaints such as tiredness, headaches and
muscular aches and pains. Women also have higher rates than men for
poor mental health, particularly related to anxiety and depressive disorders.
The World Health Organization suggests that gender differences in health are
related to both biology and social factors. ‘Social factors’ refer to distinct
roles and behaviours for men and women in a given culture, dictated by
that culture’s norms and values for gender.
Health inequalities
Gender and social factors
Social factors offered to explain the higher mortality rates in men:
Employment: men are more typically found in occupations involving direct risk to
life, such as operating dangerous machinery and exposure to environmental
hazards and toxic substances.
Risk-taking behaviour: men are more likely to engage in dangerous sports and are
at greater risk of road traffic accidents. They tend to drive longer distances than
women and to drive faster, and are more likely to drive under the influence of
alcohol.
Smoking: older men are more likely than women to be or to have been heavy
smokers, though the gender gap has narrowed and now girls below 15 are more
likely than boys to smoke.
Alcohol: men drink significantly more than women in all age groups.
(‘Women and Health’ A. Scambler, 2008)
Question: Can you suggest any other gender-related factors?
Health inequalities
Conclusion (1)
In their book The Spirit Level (2009), Richard Wilkinson and Kate Pickett
argued that income inequality was linked to health and social
problems. Karen Rowlingson (2011) conducted an independent review
of the research into the effects of income inequality, with particular
reference to the arguments put forward in The Spirit Level.
Among the conclusions were:
•
Evidence from a range of studies suggests that there is a correlation
between income inequality and health and social problems.
•
Those with higher incomes do better on a range of outcomes. There is
a ‘social gradient’ in health, meaning that with every step up the
socio-economic ladder there is an increase in health.
Health inequalities
Conclusion (2)
There is less agreement among studies regarding whether income
inequality causes health and social problems, though some rigorous
studies provide evidence of such a relationship.
Some research suggests that inequality is particularly harmful after it
reaches a certain threshold. Britain was below this threshold up to the
early 1980s but rose above it in 1986–7 and has been well above the
threshold since 1998–9.
The most plausible explanation for inequality’s effect on health is ‘status
anxiety’. Inequality is harmful because it places people in a hierarchy
that increases status competition and causes stress, which leads to
poor health and other negative outcomes.
(‘Does income inequality cause health and social problems?’ K. Rowlingson, Joseph Rowntree Foundation
report September 2011.)