Distribution of health and Illness Social Class

Aims & Objectives Analyse data that demonstrates health inequality (class, gender, ethnicity) Analyse sociological explanations for health inequalities (class, gender, ethnicity)

What are the 4 definitions of health?

How can we determine that health and illness are socially constructed?

What do you think influences health?  Nature and biology  Lifestyle factors  Environmental factors Illness is determined by much more than just biology

Sociological Approaches  Health and illness are not just natural or biological  Health and illnesses is shaped, distributed and understood in relation to social factors

What is Social Class?

Sociological Approaches Poverty creates illness Sick people become poor Unhealthy ‘lifestyles’ are shaped by economic and social circumstances

In most societies women live longer than men, though women experience more ill-health. There are also major differences by social class and ethnicity within societies

 Men, Afro-American, and poorer people on average die younger than, women, whites and more affluent individuals

 For every person who dies in any given year, many more experience illness or disability. Affecting their quality of life

Explaining these patterns of health and illness, or the distribution of specific illnesses, is far from easy. It is fashionable among the public and the medical profession to focus on so-called ‘health- related behaviours’,.

Distribution of Illness  However, sociologists generally seek to move beyond these individual behaviours, and to understand health and illness in terms of the broader features of society

The Black Report The Black Report gathered evidence of differences in the standardised mortality ratios of different social classes in Britain.

The Black Report In the case of adults between the ages of 15 & 64…the higher the social class the lower the mortality rate…and the lower the social class the higher the mortality rate

For example, Inequalities in Health: The Black Report ( P. Townsend and N. Davidson, 1982) In Britain death-rates of those aged 15 to 60 were two and a half times as high for a person in social class V than in class I, and there is no sign of these differences declining.

Explanations for Health Inequalities  The Black Report 1980 identified 4 possible explanations for Health inequality:  Artefact explanation  Social Selection  Cultural Differences  Material Differences

Artefact Explanation  The artefact explanation of health inequalities rests on the idea that the relationship between class/gender/ethnicity and health is artificial rather than real.  It arises either through the (inadequate) measurement of social class/gender/ethnicity and/or health, or in the measurement of the relationship between the two.

Artefact Explanation  How do you think the artefact explanation could be used to explain the inequalities experienced by the group that you presented research on?

Social Selection  The differences in social class reflect the fact that healthier people are more able to work their way up the social class structure

Social Selection  How do you think the Social Selection explanation could be used to explain the inequalities experienced by the group that you presented research on?

Cultural Differences  Particular cultures are more likely to engage in unhealthy lifestyles.

Cultural Differences  How do you think the Cultural Differences explanation could be used to explain the inequalities experienced by the group that you presented research on?

Material Differences  The economic differences in Britain lead directly and indirectly to poorer health for the less well off and an increased chance of early death.

Material Differences  How do you think the Material Differences explanation could be used to explain the inequalities experienced by the group that you presented research on?

Young poor have more disorders  According to the Guardian newspaper (1999) children of poor families are 3 times more likely to suffer a mental disorder than those brought up in well- off households

Class and Mortality  At every stage of life, from birth to old age, mortality and survival rates show similar patterns  The higher the occupational class, the better the chance of survival  The lower classes are more vulnerable to ‘killer’ diseases.

Class and Mortality  Townsend noted that lower class males were higher in 65 out of 78 disease categories  And for females in 62 out of 82

Class and morbidity  Lower socio-economic groups experience more sickness and ill-health throughout their lives.  Lower class children tend to have a lower birth weight. During childhood they are more likely to suffer from obesity, hearing and visual impairment, accidents and dental problems.

Why the poor are sicker!

Using the recourses available to you in the LC…In groups decide and identify the reasons that might explain why lower social classes tend to have a higher mortality and morbidity rates than those in higher social classes. Use statistics to support you findings

Explanations for differences in social class rates of illness. A critical view Can the statistics be trusted?

Why the Stats might be wrong  Illsley (1986,1987) criticised the statistics in the Black Report for concentrating on the inequality between the highest and lowest classes, whilst neglecting the improvements in the health of most people.

Why the Stats might be wrong Carr-Hill (1987) pointed out that often death certificates identified the wrong profession. This would mean that the social class would also then be wrong.

Why the Stats might be wrong  Saunders (1993) suggests the conventional uses of the terms social class ignore differences in consumption and lifestyles, which have become increasingly important

Ill health creates social class  Illsley says it is easy to assume that the fitter, healthier people take the higher social positions, are likely to be promoted and have the opportunity to work hard.  Wadsworth (1986) identified a correlation between childhood illness and adult social status.

Social class creates ill health  However to contradict this Shaw et al (1999) have pointed out that lower social classes are faced with economic, social and employment issues that do indeed create ill health, and not the other way round.

Cultural factors  Lower social classes are more likely to engage in risky or unhealthy lifestyles, which have an effect on long term health and can also lead to death.  Is this a direct result of their circumstance?

A very Marxist approach  Capitalism may benefit from differences in lifestyle…money is made from an unhealthy lifestyle, and so they continue to advertise and promote this type of lifestyle.

So what did the black report find? And what are the explanations?

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

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