SOCIAL CLASS & OTHER INEQUALITIES IN HEALTH Kai-Lit Phua,PhD FLMI Associate Professor School of Medicine & Health Sciences Monash University Malaysia

Biographical Details Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology (Medical Sociology)from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and for the Managed Care Department of a leading insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003.

EPIDEMIOLOGY Study of the determinants (“causes”) and distribution of disease in human populations. Epidemiologists look for possible relationships between disease and these factors: Social Class (“Class”) Ethnicity (“Race”) Gender (“Sex”) Age Region e.g. urban, suburban, rural e.g. low income country, middle income country, high income country Other e.g. education, “illegal worker” status

UNEQUAL DISTRIBUTION OF DISEASE Ethnicity: In Malaysia, Orang Asli have the worst health e.g. malnutrition is more common, they experience more disability and higher rates of disease, and they die younger Gender: Males are at higher risk of dying from certain health conditions. Females are at higher risk for other health conditions. Age: Young children and old people Region: Rural people generally have poorer health than urban people. In the cities, slum dwellers have poorer health than non-slum dwellers.

DISTRIBUTION OF DISEASES ARE AFFECTED BY SOCIOECONOMIC FACTORS Other socioeconomic factors: Education: Better educated people tend to have better health Illegal workers: They are at higher risk of developing occupational-related diseases

UNEQUAL ACCESS TO HEALTH SERVICES Julian Tudor Hart’s “Inverse Care Law”: People who need health services the most are the least likely to get them Why? Because of barriers to access: Financial barriers e.g. unable to pay, cannot afford to take time off from work to see the doctor Geographic barriers e.g. too far to travel Cultural barriers

SOCIAL CLASS IS A VERY IMPORTANT FACTOR RELATED TO HEALTH A person’s “social class” position is strongly linked to his or her health status. Social Class is measured either by a person’s INCOME or OCCUPATION Social Class Groupings: Upper Class, Middle Class, Working Class, Underclass

THE SOCIAL CLASS GRADIENT IN HEALTH People from lower social classes usually experience higher disability rates, higher morbidity rates, higher mortality rates and have lower life expectancy (than people from the upper classes) Thus, “The lower the social class, the lower the health status of people”

THE SOCIAL CLASS GRADIENT IN HEALTH It is NOT a statistical artifact: No matter how “social class” is measured, the relationship between low social class and low health status is found in every country where health statistics are collected

REASONS FOR THE SOCIAL CLASS GRADIENT IN CLASS Poverty e.g. not enough money to buy proper food, being forced to live in poor quality housing in unhealthy or high crime areas 2) Lower class people are less well-educated and have less knowledge of healthy lifestyles 3) Class differences in health-related behaviour 4) More dangerous jobs of lower class people 5) More stressful lives of lower class people

SOCIAL CLASS AND HEALTH A low social class position can have a negative effect on health But, poor health can also lead to a fall in social class position (the “Downward Drift” hypothesis) e.g. people who become alcoholics or drug addicts, people who cannot work because of bad health etc can fall into poverty

CAN EQUAL ACCESS TO MEDICAL SERVICES ELIMINATE THE SOCIAL CLASS GRADIENT? In 1947-48, the British Government established the NHS (National Health Service) and made access to medical services equal for all social classes. However, the social class gradient continues to persist in Britain (documented by the “Black Report”) Thus, we conclude that good health depends on more than just access to medical services

THE END THANK YOU