1. Causes of Inequalities in Health: Socio-economic Status

2. Inequalities in Health
A number of studies have been carried out by
various groups over the years.
Their reports revealed:
the nature of health inequalities
the scale of the health inequalities
the causes of these inequalities in the UK.

3. The following studies into health inequalities have found a causal link between social class and the incidence of ill health.
The Acheson Report
(1998)

4. Social Class Occupation Income level Housing Education
To understand the link between social class and ill health, we need to be clear what is meant by social class.
A person’s social class is based on a mixture of factors:
Occupation
Income level
Housing
Education

5. Registrar General’s Classification of Social Class
Categories I
Higher managerial, administrative, professional.
Accountant, bank manager, dentist, doctor, solicitor. II
Lower managerial, administrative, professional.
Farmer, librarian, sales manager, teacher.
IIIa
Non-manual: Clerical and minor supervisory.
Clerk, police officer, shop assistant
IIIb
Skilled manual: Clerical and minor supervisory.
Electrician, mechanic, plumber. IV
Semi-skilled manual.
Assembly line worker, builder, lorry driver. V
Unskilled.
Cleaner, labourer.

6. The Black Report (1980) Remit
To investigate the problem of inequalities in health in the UK.
To analyse the lifestyles and health records of people from all social classes (based on the Registrar General’s categories).

7. The Black Report (1980) Findings
The health of the nation had improved generally but the improvement had not been equal across all the social classes.
Gap in inequalities of health between lower and higher social classes was widening.

8. The Black Report (1980) Findings
Health standards were directly linked to social class.
Ill health increased down the social scale.
The problem had little to do with the NHS.
Problems were linked with social and economic factors such as:
income
unemployment
poor environment
poor housing
education

9. The Black Report (1980) Findings
Key causes of inequalities in health were:
Low
income
Sub standard
housing
Unemployment
Poor
education
Poor
environment

10. The Black Report (1980) Recommendations
Report contained 37 recommendations which focused on two main areas:
of spending
more money on
health education
and the
prevention of
Illness.

11. The Black Report (1980) Reaction by Government
When the Report was published there was a change of government. Conservatives were now in government and they criticised the Report.
Report did not
explain inequalities
in health.
Spending more on
health services would
make no difference
to health
standards.
Contrary to what the Report said, poor people did use health services.

12. Argued that individual behaviour within social
The Black Report (1980)
Problem was:
They wanted to reduce
public expenditure
Regarded
the Report
as old-fashioned,
socialist
explanations
of ill-health
Took the
individualist
approach –
people should
eat, drink
and smoke
less
Government
disagreed
Argued that individual
behaviour within social
classes shaped health

13. The Health Divide (1987) Remit
This Report, also called the Whitehead Report, concentrated on social class as one of the main causes of inequalities in health.
The Report was commissioned by the Health Education Council (HEC) in 1987 and headed by Margaret Whitehead.
Her remit was to update the evidence on inequalities in health and to assess the progress made since the Black Report six years earlier.

14. The Health Divide (1987)
The HEC was a quango – a body set up by the government but able to work independently, in theory.
Findings
Revealed that the gap between health standards and social class had widened since the publication of the Black Report.
Restated the direct link between health and social class.

15. The Health Divide (1987) Government reaction
Just when the Report was being commissioned, the government announced that the HEC was to be scrapped.
HEC was campaigning on alcohol, tobacco and diet issues which upset some of the government’s financial supporters – tobacco manufacturers gave a lot to party funds.
One week before findings were due to be made public, a press conference was cancelled with no explanation. Clearly pressure had been put on the Chairman of the HEC to cancel because of the controversial nature of the report’s findings.

16. “Working Together for a Healthier Scotland”

17. The Acheson Report (1998)
This was an independent study into health inequality.
It was commissioned by the new Labour government in 1997, under the chairmanship of a former Chief Medical Officer for England and Wales, Sir Donald Acheson.
Remit – to investigate health inequalities in the UK.

18. The Acheson Report (1998)
It was a very comprehensive survey of those in society described as disadvantaged.
Its findings mirrored those of the Black Report.
The root cause of inequalities in health was poverty.
It concluded that in order improve the health of millions, the gap between the richest and poorest in UK society had to be reduced.

19. The Acheson Report (1998) Findings
Children from poor families weighed on average 1.30gms less than those from wealthy families
Infant mortality rates:
7/1000 – lower social classes
5/1000 – upper social classes
Long term illness
17% of profession men aged 45-64
48% of lower class men aged 45-64
Income levels
2.2 million children live on income levels 50% below the national average
Health campaigns
Higher uptake of screening amongst upper social classes – widened health gap

20. The Acheson Report (1998) Findings
Poor men are 68% more likely to die in middle age than richer men.
Poor women are 55% more likely to die young.
Health inequalities start before birth
A key factor in low weight babies is the mother’s birth weight and her pre-pregnant weight.
Risk increases
Social class I
Coronary heart disease
Strokes
Lung cancer
Accidents & suicides
Respiratory diseases
Social class V

21. Scotland Health Survey 2003