Social Class HEALTH Inequalities - PowerPoint Presentation

Slide1

Social Class HEALTH Inequalities

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Recap: How many can you explain?

Objective & Subjective definitions of social class

Registrar General Scale (RGS)

NS-SEC

Underclass

Working class culture

Means of Production

Embourgeoisement

Proletarianization

Aristocracy & Super-Rich

Ascribed/Achieved StatusesSlide3

Discuss

Why is OCCUPATION a useful measure of social class?

What are some problems with using OCCUPATION as a measure of social class? What are the problems with the NS-SEC?Slide4

Problems

The majority of the population do not have an occupation

The NS-SEC is generally based on the highest earner in a household, therefore ignores many people’s occupations.

A classification based on occupation alone ignores other factors of inequality.

Within a single occupation, there can be various levels of income, work-situation and lifestyle…Slide5

Social Class Health Inequalities: Activity

In pairs, study the graphs on the hand-out and answer the questions provided.

10

minsSlide6

Social Class & Mortality Statistics

Rate of stillbirths and premature infant deaths significantly higher for unskilled families than for professional families…

…Children from poorer families are 5 x more likely to die in an accident than those from wealthier families.

A person born into social class 1 lives (on average) about 7 years longer than someone in social class V.

Around 90% of the major causes of death are more common in social classes IV and V than in other social classes.Slide7
Slide8

Studies…

The Black Report

(1982) and

The Health Divide

(1992) show that members of the lower-classes continue to experience higher mortality rates.

These studies suggest that a considerable number of deaths could be prevented each year if all classes shared the advantages of Class I…Slide9

Social Class & Mortality Stats

Working-class people go to the doctor more often (and for a wider range of problems) than ‘professional’ people

(Browne &

Bottrill

; 1999)

.

In 2001, a health

self-assessment

question was added into the UK Census. The 2011 results are below…

http://www.ons.gov.uk/ons/rel/census/2011-census-analysis/local-authority-variations-in-self-assessed-general-health-for-males-and-females--

england-and-wales-2011/info-self-assessed-general-health.htmlSlide10

Social Class & Mortality Stats

Self-assessments of health tend to worsen down the

occupational hierarchy

.

Full-time and self-employed people are more likely to rate their health as “good”.

Neurotic disorders

are reported by 20% of unskilled manual workers, compared to 9% of professionals.Slide11

Discuss

What additional problems might there be in explaining the relationship between health and class?Slide12

Potential Problems…

Extraneous variables

(“class” is an umbrella term that incorporates a range of variables e.g. diet, geographical location, ethnicity, gender etc.)

Classes are changing

– difficult to establish patterns of health as classes change

Onset of disease is delayed –

Some diseases appear years after exposure to them, making it difficult to establish patterns.Slide13

Consider the different types of explanation. For each, decide on at least two explanations as to why

people from lower social class backgrounds experience worse health and lower life expectancies:

ARTEFACT

CULTURAL/BEHAVIOURAL

STRUCTURAL/MATERIAL

In PairsSlide14

Artefact Explanations

Researchers often focus on the differences between the

highest

and

lowest

classes. These are the

extremes

, ignoring everything in between…

Artefact Explanations

suggest that social class health inequalities are not real; they are just a product of statistics…

…There is no convincing support for this view. Almost all researchers agree that class differences in health are both real and serious.Slide15

Social Selection Explanations

Class

does not effect health as much as

Health

effects class…

…People

with poor health fail to get good qualifications and/or good jobs and therefore are concentrated in the lower classes Slide16

Discuss (Pairs):

List five ways in which people become

upwardly mobile

(e.g. improve on the position they were born into)?

For each, explain how ill health could prevent this happening fully.Slide17

Social Selection Explanations

Wealthier classes appear statistically healthier because healthy people are more likely to become wealthy…

…Lower classes appear statistically less healthy because unhealthy people of all classes end up in the lower classes…

So health influences the direction in which people move up or down the social scale.Slide18

Evidence in support of social selection

Wadsworth (1995)

claimed that boys who experience serious childhood illnesses are more likely to be

downwardly mobile

by age 26.

Connelly & Crown (1994)

claimed that schizophrenia is over-represented among homeless people because developing the illness puts a person at risk of homelessness.Slide19

Activity

Complete the social selection activity on the worksheet provided.Slide20

Issues with Social Selection Explanations

Illness does not always lead to downward mobility. Some people adapt to illness and continue with their careers…

…Likewise, good health does not guarantee upward mobility. Appropriate qualifications and experience are much more important.Slide21

Cultural Explanations

Inequalities in health are the result of differences in

norms, values, attitudes, lifestyle

and

behaviour

between social classes.Slide22

RECAP:

What are the features of working class culture according to Willis (1977)?

Could any of these lead to ill health?

Why might the

lifestyles

of upper class people ensure they are healthier?Slide23

Cultural Explanations

Annandale & Field (2007)

claimed that working-class people have more

negative definitions

of health. They also have

lower expectations

of health, considering it in

fatalistic terms.

This can impact their

health behaviours…

Pairs: Identify a minimum of FIVE behaviours which might increase one’s risk of illness or premature death…Slide24

Studies tend to conclude that working-class people…

Smoke More…

Drink More…

Eat less well…

Exercise less…Slide25

From Cancer Research UK:Slide26

Cultural Explanations

“Much ill health in Britain today arises from over-indulgence and unwise behaviour. Not surprisingly, the greatest potential and perhaps the greatest problem for preventative medicine now lies in changing behaviour and attitudes to health…”

(The Labour Party –

Prevention & Health

- 1977)Slide27

Problems with Cultural Explanations

Accused of

blaming the victim

(e.g. if the lower classes suffer worse health, it’s their own fault…)

Townsend (1999)

points out that some people have more freedom to ‘choose’ a healthy lifestyle than others. Poorer people adopt unhealthy behaviours as a response to their situation…

Blackburn (1991)

claims that improving the income for poorer families will improve their eating patterns…Slide28

Structural/Material Explanations

Social class inequalities are caused by the structure of society and people’s different living/working conditions.

Argue that some factors which appear to be

cultural

are actually due to other factors. For example, poor diets among the working classes is down to low income, not personal choice.Slide29

Discuss:

How could the following material factors lead to ill-health?

Long working hours?

Dangerous working environment?

Damp housing?

Low income/unemployment?

Stress?

Ext: - Suggest one solution to each of the above!Slide30

Structural/Material Explanations

Accident rates are higher amongst those in manual labour.

Those who live in poorer housing have higher rates of respiratory diseases

(Martin et al, 1987)

The material effects of unemployment are significant, leading to stress, disruption and behavioural patterns that damage health

(Morris et al, 1994)

Lobstein

(1995)

found that healthy food cost less in affluent parts of London than it did in poorer areas.Slide31

THE WHITEHALL STUDY (Marmot)

Asked why lower grade civil servants had higher rates of death from all causes and specifically coronary heart disease

Even when controlling for factors such as smoking, obesity, leisure time, height etc. the lower grades still had a risk factor of 2:1 compared to highest grade.

Concluded stress associated with lack of control was a significant factor.

http://www.abc.net.au/science/slab/stress/whithall.htmSlide32

A Sociology Exam

in which you have to answer four essay questions in ninety minutes, following a precise structure for each question.

A Sociology Exam

in which you answer four unstructured essay questions from a choice of twelve in up to four hours.

Discuss: Which would you prefer and why?

How does this relate to the Whitehall Study?Slide33

Do you agree that people of a lower social class are likely to have less control over their own work?

Do you agree that this leads to stress?

Are there any other factors that might mean people from the lower social classes experience more stress (and therefore more ill health in general)?

DiscussSlide34

An Unhealthy Environment

YouTube - Health Inequalities - Social Determinants of Health Film (Glasgow)

Individually, while watching: Identify and explain the potential factors impacting health in this short film…

Compare your responses to those of a partner.Slide35

Multiple DisadvantageSlide36

Inverse Care L

aw

(

Hart,1971)

Care is distributed in inverse proportion to need

Deprived areas have fewer GPs

People on low incomes are more likely to be dependent on public transport for getting to a surgery or hospital

People in manual work are more likely to lose pay if they take time off work

Poorly educated people are less likely to be knowledgeable about health and health services and to be assertive when dealing with doctors

Do not have the money to jump NHS waiting lists by using private servicesSlide37

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Social Class & Mental HealthSlide38

Class & Mental Health

Rogers & Pilgrim (2005)

agreed that poorer people are significantly more likely to experience mental health problems.

Stansfield

et al (2003)

found that

work

is the main factor in depressive symptoms in men: Both

lack of

employment and

inadequate

employment.

Ross et al (2001)

believed that

bad neighbourhoods

were a key influence on mental health.

Reading & Reynolds (2001)

found that anxiety about debt was the best predictor of depressive symptoms in families.

Match these studies to explanations/studies already covered in this section:Slide39

Homework

Identify and Explain TWO types of explanation for Social Class Inequalities [17]

Due: Next Lesson