1. Health & Wealth 1. Relevance to the Higher Modern Studies curriculum 2. Health and wealth not separate but interdependent 3. Contexts: a) Global b) Modern economies b) Modern economies c) USA c) USA d) UK d) UK e) Scotland e) Scotland

2. 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

3. Health and Wealth- Global Context In general: As a societys 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

4. Health & Wealth: measuring class and wealth 1. The welfare interest of the modern state in acquiring knowledge on citizens; official data gathering 2. Significance of infant mortality rates; registration of births and deaths 3. USA: Income measure – cut-off problem

5. Health & Wealth - USA 1. Federal political system 2. Health outcomes among individual states are heavily influenced by the degree of income equality within states 3. Market based health provision but state provision through Medicare (elderly) and Medicaid (poor) is significant

6. 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

7. R-G Classification of Occupations 1. Professionals and Senior management 2. Middle management 3. a) Routine clerical work b) Skilled manual work 4. Semi-skilled manual 5. Unskilled manual

8. Health & Wealth - UK 1. The significance of the establishment of the National Health Service, 1946. Health provision free at the point of delivery 2. Goal not only to improve overall health but to achieve greater equality of outcomes 3. Throughout 20th century general health has improved but class differences in health outcomes have widened

9. Health & Wealth in UK- Black Report 1. Enquiry into the effects of the NHS, published 1980, chairmanship of Sir Douglas Black 2. Findings: General health had improved in UK since the introduction of the NHS, continuing a trend from the early years of the 20 th century 3. 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

10. Black Report Evidence of increasing health inequalities despite the NHS: Class 1 1930s mortality rate = 90% of national average; 1972 = 77% Class 5 1930s mortality rate = 111% of national average; 1972 = 137%. Steady gradient from 1-5, i.e. increasing class differences

11. Health & Wealth in UK- Acheson Report 1. Report delivered in 1998 2. Class inequalities had increased further since the Black report 3. Mortality rates among occupational groups showed persistent increase of differential outcomes, to the benefit of higher occupational groups, even over a relatively short period time

12. Acheson Report 1. In mid-1970s: 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% 2. In mid-1970s: 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%. 3. 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 1990s 4. Inverse Care and Inverse Prevention Laws

13. Accidents arent Random Audit Commission Report 2007: 1. Children of never unemployed/long term unemployed parents are: a) x13 more likely to die from unintentional injury and b) x 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 2. 2. In England, 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

14. Tackling Inequalities: Dept of Health 2006 1. Spearhead areas of greatest health deprivation 2. Response to official goal to reduce class-based health inequalities by 10% by 2010. 3. Evidence that the gap between mortality rates and incidence of major diseases, e.g. cardiac disease and cancers, of these areas and the rest of society is increasing. 4. Thus, in order to achieve the goal trends have to be reversed.

15. Health & Wealth Scotland Deprivation Index: As deprivation of an area 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 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 c) Self-Assessment: 61% of residents of least deprived areas believed they were in good health compared to 45% in most deprived areas Source: ISD Scotland. See also the work of S. MacIntyre

16. Explaining Health & Wealth relationship Possible Explanation: Adapting arguments of a) M. Weber Life-chances how a persons 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 Taken from: Sage Dictionary of Sociology

17. Explaining Health & Wealth relationship b) P. Bourdieu Life chances are affected by access to: 1.Economic capital 2.Social capital 3.Cultural capital

18. Explaining Health & Wealth relationship Economic capital: Resources that provide wealth Relevant to distribution of e.g. 1.Housing warm/dry versus cold/damp 2.Neighbourhood play areas versus street 3.Diet fruit, vegetables versus high-fat

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

20. Explaining Health & Wealth relationship Cultural Capital Resources that give access to valued knowledge e.g. 1.Language – Doctor Patient interaction 2.Education - capacity to understand health information