1. Modern Studies Conference
Website for overheads and handouts:
Health & Wealth
Chris Wright – Dept. of Sociology
School of Social Science University of Aberdeen

2. Health & Wealth Relevance to the Higher Modern Studies curriculum
Health and wealth not separate but interdependent
Contexts: a) Global
b) Modern economies
c) USA
d) UK
e) Scotland

3. Health Data - Definitions
Mortality Rate The death rate of particular social groups. It provides a measure of health risk, improvements in the quality of health care and the comparative overall health of a group
Morbidity Rate Statistics used in the analysis of ill-health. They can be given in the form of either the number of sufferers from a particular condition or the proportion of the overall population with that condition
Source: Oxford Dictionary of Sociology

4. Health and Wealth- Global Context
In general: As a society’s wealth (Gross Domestic Product) increases so does health. But:
OECD (advanced) economies: Increases in these societies wealth have less effect on health outcomes (mortality and morbidity rates) than does the promotion of income equality within the society
Source: Wilkinson in Gordon ‘Inequalities in health’

5. "THERE IS A VERY STRONG ASSOCIATION BETWEEN INCOME INEQUALITY AND UNDER-FIVE CHILD MORTALITY AMONG THE WEALTHIER OECD COUNTRIES”
OECD countries with the highest infant mortality rate:
U.S., U.K. Canada
Collison, D. et al "Income inequality and child mortality in wealthy nations" Journal of Public Health, 2007, Vol. 29, No. 2, pp

6. Health & Wealth: measuring ‘class’ and wealth
The welfare interest of the modern state in acquiring knowledge on citizens; official data gathering
Significance of infant mortality rates; registration of births and deaths
USA: Income measure – cut-off problem

7. Health & Wealth - USA
Federal political system
Health outcomes among individual states are heavily influenced by the degree of income equality within states
Market based health provision but state provision through Medicare (elderly) and Medicaid (poor) is significant

8. Health & Wealth: measuring ‘class’ and wealth
UK: National data is typically analysed by Occupational Status, a ‘proxy’ (stand-in) for income and social class
Local studies sometimes use a deprivation index applied to regions or cities e.g. the Scottish Index of Multiple Deprivation (SIMD)

9. R-G Classification of Occupations
Professionals and Senior management
Middle management
a) Routine clerical work
b) Skilled manual work
Semi-skilled manual
Unskilled manual

10. Health & Wealth - UK
The significance of the establishment of the National Health Service, Health provision free at the point of delivery
Goal not only to improve overall health but to achieve greater equality of outcomes
Throughout 20th century general health has improved but class differences in health outcomes have widened

11. Health & Wealth in UK- Black Report
Enquiry into the effects of the NHS, published 1980, chairmanship of Sir Douglas Black
Findings: General health had improved in UK since the introduction of the NHS, continuing a trend from the early years of the 20th century
However, the better health outcomes of higher occupational groups as measured by infant mortality rates, life expectancy and inequalities in the use of medical services persisted and may have increased

12. Black Report
Evidence of increasing health inequalities despite the NHS:
Class ’s mortality rate = 90% of national average; 1972 = 77%
Class ’s mortality rate = 111% of national average; 1972 = 137%.
Steady ‘gradient’ from 1-5, i.e. increasing class differences
Sources Black Inequalities in health
Berridge Poor Health; inequalities in health before and after the Black report

13. Health & Wealth in UK- Acheson Report
Report delivered in 1998; Sir Donald Acheson
Class inequalities had increased further since the Black report
Mortality rates among occupational groups showed persistent increase of differential outcomes, to the benefit of higher occupational groups, even over a relatively short period of time
Sources: Acheson Independent inquiry into inequalities in health
Gordon Inequalities in health: the evidence

14. Acheson Report
Mid-1970’s: males in lower occupational groups had a death rate 53% higher than males in class 1 & 2; 10 years later it had risen to 68%
Mid-1970’s: females in lower occupational groups had a death rate 50% higher than females in class 1 & 2; 10 years later it had risen to 55%.
If all groups had the same death rate as groups 1 & 2 over this period, there would have been 17,000 fewer deaths per year in the early 1990’s
Inverse Care and Inverse Prevention “Laws”

15. Accidents aren’t Random
Audit Commission Report 2007:
Children of never unemployed/long term unemployed parents are:
a) x13 more likely to die from unintentional injury and
b) x37 more likely to die as a result of exposure to smoke, fire or flames than children of parents in higher managerial and professional occupations
Children in the 10 per cent most economically deprived areas are x3 more likely to be hit by a car than children in the 10 per cent least deprived areas
Better safe than sorry: preventing unintentional injury in children

16. Childhood Road Traffic Accidents; Scotland 2008

17. “Tackling Inequalities”: Dept of Health 2006
Spearhead Initiative - areas of greatest health deprivation in England & Wales= 28% of the population
Response to official goal to reduce class-based health inequalities, infant mortality and life expectancy, by 10% by 2010.
February Official statement that only 19% of Spearhead sites would achieve their targets; in 66% of sites the gap with the national average was widening
Thus, in order to achieve the goal trends have to be reversed.

18. Current Situation
However, whilst the health of all groups in England is
improving, over the last ten years health inequalities
between the social classes have widened—the gap has
increased by 4% amongst men, and by 11% amongst
women—because the health of the rich is improving
more quickly than that of the poor.
House of Commons Health Committee: Health Inequalities.
Third report vol th March 2009 (emphasis added)

19. Health & Wealth Scotland
Deprivation Index: income, crime, employment, education etc
As deprivation increases so health outcomes worsen.
Instances a) For both men and women death rate from heart disease is x2 in most deprived as in least deprived areas
b) Cancer rates are highest and survival rates lowest in the most deprived areas. In least deprived areas the relationship is reversed
c) Self-Assessment: 61% of residents of least deprived areas believed they were in good health compared to 45% in most deprived areas
Equally Well :
Information Services Division (ISD) Scotland
See also the work of S. MacIntyre

20. Stroke and Deprivation: Scotland

21. Heart Disease & Deprivation; Scotland

22. All cancers: Scotland 2006

23. Current Situation Scotland’s health is improving rapidly but it is
not improving fast enough for the poorest
sections of our society. Health inequalities…
remain our greatest challenge
Equally Well: report of the ministerial task force on health
inequalities vol. 2
June 2008

24. Explaining Health & Wealth Relationship
Possible Explanation:
Adapting arguments of
a) M. Weber
Life-chances how a person’s relationship to the ownership of property and scarce skills affects their ability to achieve their goals such as high quality education, good health, secure employment.
Source: Sage Dictionary of Sociology

25. Explaining Health & Wealth relationship
b) P. Bourdieu
Life chances are affected by access to:
Economic capital
Social capital
Cultural capital

26. Explaining Health & Wealth relationship
Economic capital: Resources that provide wealth
Relevant to distribution of e.g.
Housing warm/dry versus cold/damp
Neighbourhood play areas versus street
Diet fruit, vegetables versus high-fat

27. Explaining Health & Wealth relationship
Social Capital: Resources that create social solidarity and access to valued networks
Relevant to distribution of :
Support – Mutual assistance (Rosetto) (Glasgow)
Trust – Encouragement to be healthy (Aberdeen)

28. Explaining Health & Wealth relationship
Cultural Capital: Resources that give access to valued knowledge e.g.
Language – Doctor - Patient interaction
Education - capacity to understand health information

29. The End
Good Luck