1. Health and Social Inequalities

2. Tackling Health Inequalities This involves using interventions that contribute to an improved health outcome amongst groups who have disproportionately poorer health than the rest of the population Occupation is used as an indicator of inequality because it is linked to: –Status & prestige –Income –Attitudes & lifestyle –Conditions of life

3. Measures used Individuals –SEC scheme replaced the Registrar General’s social class classification Groups –Measures used are area based - e.g. deprivation measures of Townsend, Jarman & IMD Social inequality & health has an inverse relationship. –Lower social class position is linked to increased mortality (& influence of area)

4. Explanations for differences: 1.Artefact 2.Health Selection 3.Cultural/behavioural 4.Materialist/social structural

5. 1. Artefact Numerator-denominator basis –Problems in coding numerator –Denominator is the social class structure during the decennial census Registrar General’s system Lack of reduction in inequalities associated with a reduction in % of population in poorest classes

6. 2. Health Selection Inter-generational selection –health status in childhood affects social mobility and later health (indirect) or health status and socio-economic position in early adulthood (direct) Intra-generational selection –sick people drift down social hierarchy, while healthy people move up But how large is this impact?

7. 3. Cultural/Behavioural Shared and learned attitudes and way of life for different social groups influence risks of ill health Health is a matter of individual responsibility and free choice (influence attitudes/knowledge) Make important contributions to mortality risk but do not adequately account for the differences between social groups

8. 4. Materialist/Social Structural Material conditions of life lead to increased risks of disease Each factor (housing, unemployment, physical & psychological risks of work conditions, poverty) makes a modest contribution to the total social class gradient in health Differential exposure to physical hazards determined by the distribution of income and opportunity Clustering of advantage and disadvantage over the course of life

9. Other Health Inequalities Race & Health –Problems with definitions; in UK, linked with socio- economic group & place Gender & Health –Biological explanations –Psycho-social (personality differences) –Occupational & work related factors –Social roles & expectations –Social structural differences