1. Health inequalities and social class Week 17 Sociology of Health and Illness

2. Recap Thought about how health and illness are structured by society Considered the ‘sick role’, medicalisation and surveillance medicine Looked at ‘lay’ understandings of health

3. Outline Outline the impact of social class on heath Consider completing explanations Consider how health status is individualised

4. Impact of Social Class The impact of social class on health has been debated since the mid-19th century The poor are sicker and die earlier than the rich Charities and campaigns intervene to help –Factory and Sanitation Acts, Charity Hospitals

5. Treatment for all? During the early 20th century access to medical treatment was increased The most significant step was the National Health Service Act in 1946. The service launched on 5 July 1948, and it was hoped that this would significantly reduce health inequalities

6. NHS Introduction http://www.nationalarchives.gov.uk/films/1 945to1951/filmpage_cyvgh.htm

7. Did it make a difference? A study was to commissioned in the 1970s by the Labour Government to examine health inequalities The Conservative government tried to bury the outcome But the ‘Black Report’ showed the extent of class differences

8. Health inequalities today Acheson Report (1998) –Death rates have fallen but class differences increased for all major causes of death –Premature mortality (death < 65) is higher among people who are unskilled. ONS found 18.3 disability-free years between best and worse areas Doring found up to 10 years life expectancy difference

9. Why do you think the health inequalities have persisted? Should we be concerned about it?

10. Explaining class inequalities The Black Report set out for main reasons why an association between poverty and health could be seen –Artefact –Health Selection –Cultural –Materialist Each reason leads to different actions

11. 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 Draws on ideas about the social construction of illness

12. 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

13. 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

14. 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

15. Two new theories Since the Black Report two additional explanations have been added –Psycho-social –Life course Both try to explain complexity and trends in health data

16. Psycho-social Data suggests that it is not wealth per se that is important in determining health Wilkinson suggests it is the degree of inequality (gap between rich and poor) Two key concepts are –Social cohesion –Self-esteem Reflected in current policy on social inclusion/exclusion

17. Life-course The life-course interpretation focuses on circumstances across the lifespan It includes an emphasis on maternal health Health is a cumulative concept which can include material and cultural factors

18. Which reason(s) for health inequality do you think is most likely?

19. Individualising health? The Black Report and most other sociological studies have argued that the strongest explanations take seriously structural factors Social class matters, yet both individuals and governments stress behavioural factors

20. Marxist explanations Marxism has always seen disease (and treatment) as outcomes of capitalism Engels argued that industrial capitalism caused ‘Social murder’ Health care is part of the capitalist mode of production

21. Marxist explanations Navarro argues that the organisation of healthcare –Redefines social problems as medical ones so legitimates the status quo –The emphasis on high-tech scientific medicine forms part of the capitalist economy –Reproduces class inequalities within the organisation of health care and patterns of consumption

22. To what extend do you think healthcare is a part of the capitalist economy?

23. Marxist explanations Redefining social problems? –Shift-work sleep disorder? High-tech scientific medicine –2002 Combined Profit of Top Ten Pharmaceutical was over US$35 billion –NHS in England spends £7 billion pa Reproduces class inequalities –Middle-classes become doctors –Who shouts loudest gets treated?

24. Summary Look at the evidence for an association between class and health Considered different explanations Considered Marxist views on health as a part of the capitalist economy

25. Next week Continue to consider health inequalities by focusing on gender Do women get sicker but men die quicker? Look at explanations for gendered patterns